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