| NPI | 1326039827 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA RYAN Chief Nurse Practioner For Tchs 484-832-4468 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: OR 200250141NP FNP-PP) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2020-08-22 |