| NPI | 1225527989 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA MONTGOMERY Administrator 346-262-2669 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| Enumeration Date | 2018-05-08 |
| Last Update Date | 2024-02-02 |