| NPI | 1609202449 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER AMBER FACTEAU-RABIDEAU Owner 518-310-3090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health |
| Enumeration Date | 2013-09-25 |
| Last Update Date | 2013-09-25 |