| NPI | 1104617141 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERYL ANNETTE WATHEN CFO 812-450-3296 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2025-05-16 |
| Last Update Date | 2025-05-16 |