| NPI | 1598534711 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE JACKSON Manager/Employee 302-232-6172 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-12-28 |
| Last Update Date | 2023-12-28 |