| NPI | 1649805607 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNET M MUKASA Practice Owner 857-312-5626 |
| Organization Subpart ? | No |
| Primary Taxonomy | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health |
| Enumeration Date | 2020-03-10 |
| Last Update Date | 2025-08-22 |