| NPI | 1508554742 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY FLANNELLY Nurse Practitioner 848-404-6717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 251S00000X |
| 261QH0100X Clinic/Center, Health Services | |
| Enumeration Date | 2023-04-26 |
| Last Update Date | 2023-04-26 |