| NPI | 1194195834 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL K SPENCER Owner 276-768-9058 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: VA 0017142291) |
| Enumeration Date | 2015-10-06 |
| Last Update Date | 2015-10-06 |