| NPI | 1528658416 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATOYA MULLEN Owner 757-202-6461 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2021-01-25 |
| Last Update Date | 2022-01-23 |