| NPI | 1659215382 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIAM OMOTOYOSI OPAFUNSO Manager 346-769-5790 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2026-04-15 |
| Last Update Date | 2026-04-27 |