NPI | 1124772009 |
---|---|
Entity Type | Organization |
Authorized Contact | OCTAVIA GREEN Administrative Program Specialist B 318-362-3270 |
Organization Subpart ? | Yes |
Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
Additional Taxonomies | 363LF0000X Nurse Practitioner Family |
Enumeration Date | 2022-02-09 |
Last Update Date | 2023-08-30 |