| NPI | 1275710907 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SALVATORE JAMES BERTOLONE President 502-629-7750 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2008-01-24 |
| Last Update Date | 2008-01-24 |