| NPI | 1104494475 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERICA JOHNSON Owner 419-309-2659 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology Addiction Psychiatry |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2022-03-15 |