| NPI | 1154807469 |
|---|---|
| Other Name | MAINE |
| Other Name | OREGON |
| Other Name | NEW HAMPSHIRE |
| Entity Type | Organization |
| Authorized Contact | SUSAN PORTER Director 615-500-2199 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2018-07-19 |
| Last Update Date | 2024-08-15 |