| NPI | 1366299406 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER MARIE GOELLNER Owner 234-802-9180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-05-06 |
| Last Update Date | 2024-05-24 |