NPI | 1558627158 |
---|---|
Entity Type | Organization |
Authorized Contact | REBECCA R DICKERSON Owner 256-232-0475 |
Organization Subpart ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-093181) |
Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health (Licence: AL 1-093181) |
Enumeration Date | 2012-04-09 |
Last Update Date | 2012-04-09 |