| NPI | 1023599198 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARSHANELLE HORNE Owner 331-300-1440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 041330336) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036099659) |
| 363L00000X Nurse Practitioner (Licence: IL 041330336) | |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2021-09-30 |