NPI | 1437808433 |
---|---|
Entity Type | Organization |
Authorized Contact | JENNIE KRULL Medical Director 224-465-4309 |
Organization Subpart ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
Enumeration Date | 2022-03-18 |
Last Update Date | 2024-07-11 |