| NPI | 1417687880 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA HAVERKAMP Nurse Practitioner / Administrator 316-665-7165 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2022-06-16 |
| Last Update Date | 2022-06-16 |