| NPI | 1639834757 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY POVENSKI Director Of Operations 800-920-6748 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2021-11-03 |
| Last Update Date | 2022-03-11 |