| NPI | 1346426467 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY CARSON Manager, Payer Enrollment 234-312-5691 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 2086S0129X |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2008-01-18 |
| Last Update Date | 2025-10-09 |