| NPI | 1053936427 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID KEATLEY WALDRON Managing Member 863-382-4445 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2020-06-11 |
| Last Update Date | 2020-06-11 |