| NPI | 1447904479 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRAIG WADE Owner 985-381-3811 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2022-02-08 |
| Last Update Date | 2022-12-15 |