| NPI | 1518467935 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERI L NIES Owner 239-220-8875 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9220215) |
| Enumeration Date | 2018-02-13 |
| Last Update Date | 2018-02-23 |