| NPI | 1487419057 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MUNACHI EZENWATA Nurse Practitioner 725-200-1050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2024-02-14 |
| Last Update Date | 2024-02-15 |