| NPI | 1134825664 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA BRANDENBURG Owner/Np 849-358-2051 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2023-02-06 |
| Last Update Date | 2023-04-20 |