| NPI | 1356493084 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOELLEN WYNNE Owner 512-507-9525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 200050118NP) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2020-08-22 |