| NPI | 1174096465 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD P LINDAHL COO 833-765-3648 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 261QI0500X Clinic/Center, Infusion Therapy |
| 261QM2500X Clinic/Center, Medical Specialty | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2019-01-09 |
| Last Update Date | 2022-09-27 |