| NPI | 1609574029 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES O'HARA Owner 618-518-0872 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2023-02-16 |
| Last Update Date | 2023-02-16 |