| NPI | 1609680487 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT SHAWN BRONKE Manager, Provider Enrollment 469-466-7424 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| 363LF0000X Nurse Practitioner, Family | |
| 363LG0600X Nurse Practitioner, Gerontology | |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2025-02-03 |
| Last Update Date | 2025-05-29 |