| NPI | 1215754049 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER LANNING Owner 765-480-1832 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family |
| Additional Taxonomies | 261QU0200X Clinic/Center Urgent Care |
| 207R00000X Internal Medicine | |
| 207RN0300X Internal Medicine Nephrology | |
| Enumeration Date | 2024-09-23 |
| Last Update Date | 2025-07-30 |