| NPI | 1346428661 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER MELISSA DANVER Office Manager 386-673-2770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics |
| Enumeration Date | 2008-02-08 |
| Last Update Date | 2020-11-16 |