| NPI | 1568094670 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YVETTE WISENER Billing 256-258-9603 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2020-02-06 |
| Last Update Date | 2022-09-02 |