NPI | 1508636945 |
---|---|
Entity Type | Organization |
Authorized Contact | RENEE M GOODRICH Owner 574-780-0102 |
Organization Subpart ? | No |
Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
Enumeration Date | 2024-01-08 |
Last Update Date | 2024-03-30 |