| NPI | 1144893173 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAYRA C KOEDAM Nurse Practitioner 972-900-8640 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2021-07-19 |
| Last Update Date | 2021-07-19 |