| NPI | 1013426329 |
|---|---|
| Doing Business As | CALEDONIA COMMUNITY CLINIC |
| Entity Type | Organization |
| Authorized Contact | AMANDA FONDREN Nurse Practitioner/Owner 662-855-0080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MS r858548) |
| Additional Taxonomies | 363LC1500X Nurse Practitioner, Community Health |
| 363LF0000X Nurse Practitioner, Family | |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2017-09-29 |
| Last Update Date | 2018-05-22 |