| NPI | 1417796608 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNA SISCO Owner 606-262-0451 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Enumeration Date | 2024-05-20 |
| Last Update Date | 2024-05-20 |