| NPI | 1043616154 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FARRAH MARIE HASSEBROEK Owner 712-301-1102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IA G-115089) |
| Enumeration Date | 2014-11-17 |
| Last Update Date | 2014-12-22 |