| NPI | 1417372947 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER CHASTAIN Provider Enrollment 330-493-4443 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0001248546) |
| Enumeration Date | 2014-02-20 |
| Last Update Date | 2024-12-17 |