| NPI | 1659937977 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY R CLAUSS CEO 888-417-6543 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2020-04-01 |