| NPI | 1386478782 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARA BURRIS Credentialer 443-350-2092 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| 363LP0200X Nurse Practitioner, Pediatrics | |
| Enumeration Date | 2024-08-28 |
| Last Update Date | 2024-08-28 |