| NPI | 1326752437 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYRELL QUINTON HAIRSTON-GREEN Director Of Outreach 346-546-7114 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251B00000X Case Management |
| Additional Taxonomies | 251S00000X |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2023-01-12 |
| Last Update Date | 2024-02-13 |