| NPI | 1467186411 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW MORNINGSTAR Owner 618-741-0786 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2022-07-14 |
| Last Update Date | 2022-07-29 |