| NPI | 1114144300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNDEE J DETRICK Office Manager 419-893-3316 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 032039822) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: OH RN113039) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2008-04-22 |