| NPI | 1487278776 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL LANSDELL Owner 870-584-1055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208000000X Pediatrics |
| 363LA2200X Nurse Practitioner, Adult Health | |
| 363LF0000X Nurse Practitioner, Family | |
| 363LG0600X Nurse Practitioner, Gerontology | |
| Enumeration Date | 2020-06-02 |
| Last Update Date | 2020-06-02 |