| NPI | 1285488346 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARICELJEAN RYCRAFT Administrator 725-232-8649 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2024-04-15 |
| Last Update Date | 2024-04-15 |