| NPI | 1265632129 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUDY W NIELSEN Pa 918-622-5669 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OK PA545OK) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2007-07-19 |