NPI | 1326726886 |
---|---|
Entity Type | Organization |
Authorized Contact | LAURA E DANIELS Credentialing Specialist 304-429-1088 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine |
Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
363A00000X Physician Assistant | |
363L00000X Nurse Practitioner | |
Enumeration Date | 2023-07-06 |
Last Update Date | 2023-07-06 |