NPI | 1477188902 |
---|---|
Entity Type | Organization |
Authorized Contact | DAVID C WHYBREW Sole Member 918-859-5334 |
Organization Subpart ? | No |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
Additional Taxonomies | 207Q00000X Family Medicine |
207QG0300X Family Medicine, Geriatric Medicine | |
363LG0600X Nurse Practitioner, Gerontology | |
Enumeration Date | 2020-03-04 |
Last Update Date | 2021-03-23 |