| NPI | 1295500478 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA AHLERS Owner 866-316-9062 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2023-11-17 |
| Last Update Date | 2023-11-20 |