| NPI | 1649169020 |
|---|---|
| Other Name | AUTUMN LAKE HEALTHCARE AT RUXTON |
| Entity Type | Organization |
| Authorized Contact | WALTER LEWIS TOLLER Owner 667-207-3552 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 208VP0000X |
| Enumeration Date | 2025-07-01 |
| Last Update Date | 2025-07-01 |