| NPI | 1639845142 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE DAVIS CEO/Owner 317-827-2987 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 163WW0000X Registered Nurse, Wound Care | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2021-08-17 |
| Last Update Date | 2021-08-17 |