| NPI | 1346937737 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENISHA T. WOOD Nurse Practitioner/ Owner 631-219-8520 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2023-04-18 |
| Last Update Date | 2024-03-04 |