| NPI | 1083497358 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANDRA LYNN WHITE Owner 218-969-0386 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2023-08-18 |
| Last Update Date | 2023-08-22 |