| NPI | 1679097307 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIANNE BASKIN Director 386-226-7912 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2017-08-03 |
| Last Update Date | 2022-07-21 |