| NPI | 1316580665 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOMINIQUE SANDERS Pmhnp Bc 725-234-2215 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2019-10-18 |
| Last Update Date | 2021-09-14 |