| NPI | 1528719432 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY WILKENS Owner 984-315-0110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2022-01-12 |
| Last Update Date | 2022-11-17 |