| NPI | 1124856372 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHUKAIRO MACK BAKER CEO 980-309-8508 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2024-07-22 |
| Last Update Date | 2024-07-24 |