| NPI | 1427176577 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TOREY RAINESALO Credit Manager 765-521-0808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71000462) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2008-05-29 |