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