| NPI | 1528823606 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA LYNN VANDEWATER Cnp President 605-745-4128 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 261Q00000X |
| Enumeration Date | 2024-02-16 |
| Last Update Date | 2024-04-26 |