| NPI | 1043096373 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOY IKERI Admin 469-607-9331 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2023-09-01 |
| Last Update Date | 2024-01-08 |