| NPI | 1023855269 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ABIMBOLA G. ADETOLA Apn 929-625-1366 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2024-07-15 |
| Last Update Date | 2025-07-25 |