| NPI | 1174139950 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT WILLIAM DETLEFSEN Dr. Robert Detlefsen, Dnp 319-471-2479 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2020-09-17 |
| Last Update Date | 2020-09-17 |