| NPI | 1316558471 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERICA GADDY Owner 224-306-1879 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2020-08-12 |
| Last Update Date | 2020-08-12 |