| NPI | 1134760770 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FARAH EDWIDGE JOHANNE SAJOUS Owner 571-432-6769 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363LC1500X Nurse Practitioner Community Health |
| 363LP0200X Nurse Practitioner Pediatrics | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| 251S00000X Community/Behavioral Health | |
| 261QA0600X Clinic/Center Adult Day Care | |
| 291U00000X Clinical Medical Laboratory | |
| 363LA2200X Nurse Practitioner Adult Health | |
| Enumeration Date | 2019-10-04 |
| Last Update Date | 2021-11-03 |