| NPI | 1649986977 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FONDA SHANKS Director Revenue Cycle 844-969-0686 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2023-01-30 |
| Last Update Date | 2025-01-14 |