| NPI | 1477000859 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA STEVENSON Owner 419-529-2055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 18837NP) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34006500) |
| Enumeration Date | 2016-09-02 |
| Last Update Date | 2016-09-30 |