| 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 |