| NPI | 1023868338 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNA RENNELLS Authorized Official 989-675-7910 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-03-27 |
| Last Update Date | 2024-03-27 |