| NPI | 1023187234 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA CANTWELL Executive Director 502-253-4140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: KY 720224) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2009-03-12 |