| NPI | 1518302264 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY P. COSTELLO CFO 574-647-3549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: IN 71001587A) |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2016-08-30 |