| NPI | 1043798085 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEANNE E HOLDREN Owner 317-442-4437 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209.011258) |
| Enumeration Date | 2018-08-01 |
| Last Update Date | 2018-09-19 |