| NPI | 1306450960 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN J PETER Credentialing Specialist 530-868-6944 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2020-09-01 |
| Last Update Date | 2020-09-01 |