| NPI | 1144753096 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATRINA SMITH Admin 219-513-9019 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209011911) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 209011911) |
| Enumeration Date | 2017-04-07 |
| Last Update Date | 2017-04-07 |