| NPI | 1013468198 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLEY WILLBRANDT Director Shared Services 947-522-1911 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 1060000070) |
| Enumeration Date | 2016-10-24 |
| Last Update Date | 2019-08-21 |