| NPI | 1568002160 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTOR DAVIS Co Owner/Nurse Practitioner 952-288-9921 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2020-01-10 |
| Last Update Date | 2022-02-11 |