| NPI | 1164969515 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUKE SWICEGOOD VP Operations 980-505-8406 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2017-01-24 |
| Last Update Date | 2017-04-18 |