| NPI | 1073163531 |
|---|---|
| Doing Business As | EVERGREEN HEALTH |
| Entity Type | Organization |
| Authorized Contact | JESSICA ANNE STACK Associate CFO 716-847-0212 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2019-09-17 |
| Last Update Date | 2019-09-17 |