| NPI | 1407109440 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA E HIRST Owner 866-251-2425 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: AK 652) |
| Enumeration Date | 2012-10-15 |
| Last Update Date | 2012-10-15 |