| NPI | 1386264687 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TENA PAYTON-VANCE Np 734-892-4744 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2020-04-16 |