| NPI | 1609628338 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL M LATHAM Billing/Credentialing 937-309-3017 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology |
| Enumeration Date | 2024-04-04 |
| Last Update Date | 2024-06-11 |