| NPI | 1093466047 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDI DAWN TILMON Sud/Credentialing Manager 661-246-5122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2022-01-11 |
| Last Update Date | 2022-02-22 |