| NPI | 1083155824 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEANETTE MONIQUE KIDD CEO 424-396-3412 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363LW0102X Nurse Practitioner, Women's Health |
| Enumeration Date | 2017-03-13 |
| Last Update Date | 2019-11-06 |