| NPI | 1417132614 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PENNY LOGAN COO 502-558-2193 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 207RG0300X Internal Medicine, Geriatric Medicine | |
| 208100000X Physical Medicine & Rehabilitation | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2008-01-07 |
| Last Update Date | 2023-03-30 |