| NPI | 1013338425 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL WIESE Member/Partner 907-830-9225 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: AK 1121) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: AK 1121) |
| Enumeration Date | 2014-01-02 |
| Last Update Date | 2014-01-02 |