| NPI | 1528587813 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COREY S. BLACKBURN President 308-646-0077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2017-09-18 |
| Last Update Date | 2022-12-23 |