| NPI | 1205465770 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETHANY FETZER Owner 815-608-9277 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2024-12-03 |