| 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 |