| NPI | 1477447050 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARMEN LERVOLD Owner/Provider 623-352-9681 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-06-06 |
| Last Update Date | 2025-06-06 |