| NPI | 1083491419 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAGDALENE I EDO Certified Nurse Practitioner 740-415-6416 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2023-09-11 |
| Last Update Date | 2024-07-16 |