| NPI | 1548920697 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANCE CONDA Billing Manager 410-927-3510 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2021-12-29 |
| Last Update Date | 2024-09-25 |