| NPI | 1043955917 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT WADE WELLS Authorized Official 907-346-5255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health |
| Enumeration Date | 2022-05-04 |
| Last Update Date | 2022-05-20 |