| NPI | 1467225789 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATIE JEAN COLONNA Owner 928-302-3798 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2023-10-30 |
| Last Update Date | 2024-10-03 |