NPI | 1588394100 |
---|---|
Entity Type | Organization |
Authorized Contact | THOMAS MCMAHON CEO 769-243-6141 |
Organization Subpart ? | No |
Primary Taxonomy | 261Q00000X Clinic/Center |
Additional Taxonomies | 363L00000X Nurse Practitioner |
Enumeration Date | 2022-06-15 |
Last Update Date | 2022-09-21 |