| NPI | 1225806433 |
|---|---|
| Doing Business As | CCP CENTRAL CLINICAL SERVICES |
| Entity Type | Organization |
| Authorized Contact | DEBBY COONS Credentialing Manager 518-213-0478 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2023-12-18 |
| Last Update Date | 2023-12-18 |