| NPI | 1194384834 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORNA CORDELLA FORBES Owner 315-751-7127 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2019-06-06 |
| Last Update Date | 2020-07-17 |