| NPI | 1639008030 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRISCILLA Y DAVIS CEO 815-541-5045 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2026-05-14 |
| Last Update Date | 2026-05-14 |