| NPI | 1295442697 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANIQUA N WILSON Psychiatric Nurse Practitioner 917-417-4649 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2022-11-04 |
| Last Update Date | 2023-12-12 |