| NPI | 1114918935 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA J NADEAU Office Manager 270-769-1049 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3006944) |
| 363A00000X Physician Assistant (Licence: KY PA816) | |
| Enumeration Date | 2005-11-01 |
| Last Update Date | 2015-06-16 |