| NPI | 1164814414 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL ICSMAN VP, Managed Care De PT. 330-344-1657 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine |
| Additional Taxonomies | 363LC1500X Nurse Practitioner Community Health |
| Enumeration Date | 2015-02-24 |
| Last Update Date | 2015-03-05 |