| NPI | 1285456640 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHEYENNE M GASAWAY CEO 937-527-6239 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2024-10-28 |
| Last Update Date | 2025-03-06 |