| NPI | 1366318065 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA M STOUDT A RN P 509-230-3914 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2025-10-11 |
| Last Update Date | 2025-10-11 |