| NPI | 1174380141 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERICKA DEADWYLER-GOURGUE Owner 929-322-1924 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-03-05 |
| Last Update Date | 2024-11-13 |