| NPI | 1669903100 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLETTA STACKHOUSE CEO 516-515-0597 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 307783) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2024-12-31 |