| NPI | 1477198869 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NDUBUISI DAVID ODIMEGWU Owner 346-223-2195 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| 363LF0000X Nurse Practitioner, Family | |
| 363LG0600X Nurse Practitioner, Gerontology | |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2019-11-09 |
| Last Update Date | 2022-01-14 |