NPI | 1417573270 |
---|---|
Entity Type | Organization |
Authorized Contact | VANESSA LYLE Billing And Credential Specialist 667-212-3626 |
Organization Subpart ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
Enumeration Date | 2020-06-17 |
Last Update Date | 2020-06-17 |