| NPI | 1538048012 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEA JENIECE WOOLARD Nurse Practitioner/ Owner 757-214-4469 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family |
| Enumeration Date | 2025-08-29 |
| Last Update Date | 2025-08-30 |