NPI | 1619617644 |
---|---|
Entity Type | Organization |
Authorized Contact | KENISHA DAVIS Owner 708-655-1482 |
Organization Subpart ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
Additional Taxonomies | 163W00000X Registered Nurse |
363LF0000X Nurse Practitioner, Family | |
Enumeration Date | 2022-03-29 |
Last Update Date | 2023-01-31 |