| NPI | 1649902461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNSEY NIELSEN Clinical Administrator 385-388-8003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| 207Q00000X Family Medicine | |
| 207RI0011X Internal Medicine, Interventional Cardiology | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery | |
| Enumeration Date | 2022-06-29 |
| Last Update Date | 2023-08-22 |