| NPI | 1255269965 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FATINA KENDALL Owner 810-250-1106 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2026-05-12 |
| Last Update Date | 2026-06-01 |