| NPI | 1326415779 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON OSULLIVAN Owner 2149-843-9000 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics |
| Additional Taxonomies | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: TX 226944) |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2015-09-01 |