| NPI | 1457114944 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIVINE CHINYERE EZEWUZIE Owner 857-251-9231 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-02-06 |
| Last Update Date | 2024-03-12 |