| NPI | 1447048426 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIAM DIALLO-FOFANA Nurse Practitioner 708-943-7915 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-04-29 |
| Last Update Date | 2025-04-29 |