| NPI | 1366859779 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA GILMORE Business Office Manager 260-463-2133 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: IN 71004993A) |
| Enumeration Date | 2014-07-17 |
| Last Update Date | 2019-02-27 |