| NPI | 1083314298 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEANDRA LANAE THOMPOSN Owner/Provider 360-649-4030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2023-03-07 |
| Last Update Date | 2023-03-13 |