| NPI | 1184448623 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VASHTINA ELLISON-RUDDOCK Nurse Practitioner / President 202-549-0925 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2024-11-12 |
| Last Update Date | 2024-12-03 |