| NPI | 1093003550 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER CHASTAIN Provider Enrollment 330-493-4443 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2024-12-18 |