| NPI | 1578240008 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAVARE SELTUN Manager 980-745-2195 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2023-06-27 |
| Last Update Date | 2024-08-27 |