| NPI | 1649915612 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELYNNE KIMANI Pmhnp 774-420-8961 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2022-05-03 |
| Last Update Date | 2022-05-03 |