| NPI | 1447529326 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM C JERNBERG Owner 214-712-2489 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2011-12-21 |
| Last Update Date | 2011-12-21 |