| NPI | 1053037671 |
|---|---|
| Doing Business As | SCMG BREAST HEALTH CLINIC - ADDITIONAL |
| Entity Type | Organization |
| Authorized Contact | MARCIA T POLHEMUS Controller 401-788-1974 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2022-10-14 |
| Last Update Date | 2022-10-14 |