| NPI | 1437863305 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | QUIANA EAGLETAIL-DAVIS Billiing Manager 313-401-5828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-01-05 |
| Last Update Date | 2023-07-12 |