| NPI | 1114534252 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL WAYNE LANSDELL Vice President 870-584-1053 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology |
| Enumeration Date | 2020-09-23 |
| Last Update Date | 2020-09-23 |