| NPI | 1205281045 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEIDRE WELLER Controller 269-945-1212 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2016-04-29 |
| Last Update Date | 2016-04-29 |