| NPI | 1467107300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGIA ALLEN Owner 801-300-3329 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2022-02-18 |
| Last Update Date | 2024-07-30 |