| NPI | 1174353486 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELSIE DIEGUEZ-JACKSON Owner/Certified Np 315-289-6828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-08-02 |
| Last Update Date | 2025-12-24 |