| NPI | 1225606452 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY WALLENBERG Pmhnp Bc, Cnp 605-271-6582 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2021-06-14 |