| NPI | 1144937988 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEFANIE PAULUS Practice Manager 844-365-7246 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207QA0505X Family Medicine, Adult Medicine | |
| 208D00000X General Practice | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2022-11-01 |
| Last Update Date | 2022-11-01 |