NPI | 1336740059 |
---|---|
Entity Type | Organization |
Authorized Contact | VANESSA LYLE Billing Manager/ Credential Special 667-212-3626 |
Organization Subpart ? | Yes |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health |
Enumeration Date | 2020-11-09 |
Last Update Date | 2020-11-09 |