| NPI | 1619494168 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMILY-ROSE MONTGOMERY VIRDEN Owner/ Nurse Practitioner 774-213-9332 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA 2992320) |
| Enumeration Date | 2017-08-25 |
| Last Update Date | 2017-08-25 |