| NPI | 1093284937 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACI TANNEHILL Managing Member Of LLC 304-366-0111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2018-11-21 |
| Last Update Date | 2020-10-15 |