| NPI | 1457068678 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUE-ANN ADRIANS Gp Pm 945-275-1345 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2022-10-28 |
| Last Update Date | 2026-05-04 |