| NPI | 1346950565 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEAH MARIE BERGMAN Operations Manager 317-963-1612 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2022-11-29 |
| Last Update Date | 2022-11-29 |