| NPI | 1053145888 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN EVANGELISTA Owner 312-912-3444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2024-08-26 |
| Last Update Date | 2025-07-17 |