| NPI | 1649960022 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER CARRIEDO Credentialing & Contracting 800-793-7050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| 363LF0000X Nurse Practitioner, Family | |
| 363LG0600X Nurse Practitioner, Gerontology | |
| Enumeration Date | 2023-05-10 |
| Last Update Date | 2023-06-21 |