| NPI | 1003452046 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATRINA LANIER Secretary 855-485-8273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2019-11-25 |
| Last Update Date | 2025-01-03 |