| NPI | 1053022947 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE NAZAIRE Employee, Nurse Practitioner 929-348-9206 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2022-12-12 |
| Last Update Date | 2022-12-12 |