| NPI | 1043050420 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERIE A BORKORM President/Provider 815-919-4890 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2024-05-31 |
| Last Update Date | 2024-05-31 |