| NPI | 1083878730 |
|---|---|
| Other Name | PROVIDENCE HEALTH SERVICES |
| Entity Type | Organization |
| Authorized Contact | BEAU HIGGINBOTHAM VP 410-368-3168 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: DC HFD01-0212) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2008-07-11 |
| Last Update Date | 2017-06-07 |