| NPI | 1326921735 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAQWA SHAKUR Owner Of Entity 380-214-3920 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-07-31 |
| Last Update Date | 2025-07-31 |