| NPI | 1275520454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI ANN WAGNER Member 859-797-5558 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care |
| 363LF0000X Nurse Practitioner Family | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2022-08-30 |