| NPI | 1285312355 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OLUFUNMILAYO KWENTUA Provider 225-803-7593 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-07-10 |
| Last Update Date | 2024-04-15 |