| NPI | 1053176644 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER GRAVENISH Owner/Operator 712-221-0684 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-02-14 |
| Last Update Date | 2024-02-14 |