| NPI | 1184375172 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VANESSA LYLE Billing Manager 667-212-3626 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LC1500X Nurse Practitioner, Community Health |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2022-01-12 |
| Last Update Date | 2022-03-07 |