| NPI | 1578684197 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONELL JEAN CARLSON Nurse Practitioner 432-362-8400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 532880) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2008-01-17 |