| NPI | 1104506617 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANNA KAY MICHAELIS Full Independent Practice 870-317-5676 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2023-07-19 |
| Last Update Date | 2023-07-19 |