| NPI | 1306614177 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANEICE LOCKETT Owner 702-904-2819 |
| Organization Subpart ? | No |
| Primary Taxonomy | 364SP0812X Clinical Nurse Specialist, Psych/Mental Health, Community |
| Additional Taxonomies | 251S00000X |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2023-12-12 |
| Last Update Date | 2023-12-12 |