| NPI | 1295090884 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARLON R CHAGUA President 502-893-7372 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 36325) |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 363LA2200X Nurse Practitioner, Adult Health | |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2019-05-01 |