| NPI | 1295296127 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY GRUBER Physician Assistant 307-333-1123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2025-11-11 |