| NPI | 1477043552 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OSRIC A MALONE-PRIOLEAU Owner 304-699-1419 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WV 78769) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WV 78769) |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2018-11-05 |