| NPI | 1669250502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OLLIE ROGERS Owner 866-687-3348 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2023-09-21 |
| Last Update Date | 2024-11-01 |