| NPI | 1093252751 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRETT LEE WADSWORTH Owner 205-295-1001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP9706) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.0992842-NP) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60720812) | |
| Enumeration Date | 2017-01-19 |
| Last Update Date | 2017-01-19 |