| NPI | 1205319464 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETH ANN GOOD CEO 320-492-0329 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2018-09-12 |
| Last Update Date | 2024-01-25 |