| NPI | 1164228797 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY MODDESETTE Chief Administrative Officer 629-224-1614 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease |
| 207Q00000X Family Medicine | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2025-02-24 |
| Last Update Date | 2025-12-24 |