| NPI | 1295016681 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEAN WILSON Owner 336-740-0897 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD r127999) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: NJ 26NJ00418200) |
| Enumeration Date | 2011-08-30 |
| Last Update Date | 2013-06-06 |