| NPI | 1558119032 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN GIBSON VP, Finance 304-598-4256 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics |
| Enumeration Date | 2024-05-09 |
| Last Update Date | 2024-05-09 |