| NPI | 1669941175 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM CORY SHAFFER Care Coordinator 443-559-4137 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2018-11-14 |
| Last Update Date | 2024-03-15 |