| NPI | 1114652476 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUNETTE BASTIEN Owner 239-919-4851 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2022-07-20 |
| Last Update Date | 2023-02-01 |