| NPI | 1003523424 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MERRY SCHUMACHER Sr. Director Provider Services 800-400-6354 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2022-11-04 |
| Last Update Date | 2022-11-04 |