| NPI | 1629541172 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER TINKLER Owner 701-740-0052 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2019-01-08 |
| Last Update Date | 2019-11-19 |