| NPI | 1316556848 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BROOKE LOCKHART CEO 260-266-0780 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 363L00000X Nurse Practitioner | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2020-07-30 |
| Last Update Date | 2021-12-08 |