| NPI | 1528549490 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES R JERMAN CFO 731-234-8120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2018-08-28 |
| Last Update Date | 2024-10-31 |