NPI | 1356030951 |
---|---|
Entity Type | Organization |
Authorized Contact | JOHANNAH BLAKE Owner/Provider 520-372-8575 |
Organization Subpart ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
Enumeration Date | 2023-05-01 |
Last Update Date | 2023-11-10 |