| NPI | 1407283781 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PENNY LOGAN VP Of Operationa 502-558-2193 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2013-10-02 |
| Last Update Date | 2023-03-30 |