| NPI | 1255801486 |
|---|---|
| Other Name | NURSE PRACTITIONER |
| Entity Type | Organization |
| Authorized Contact | MARILYN TATHAM Provider Enrollment Manager 828-651-6595 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Enumeration Date | 2018-11-30 |
| Last Update Date | 2018-12-03 |