| NPI | 1093325557 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES R OLSEN Provider 931-250-5488 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2020-08-08 |
| Last Update Date | 2024-07-25 |