| NPI | 1013524057 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGEL L STOVER Owner 681-207-7007 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2020-09-24 |
| Last Update Date | 2023-10-10 |