| NPI | 1689498008 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW A ROSS Nurse Practitioner 218-209-7528 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-11-12 |
| Last Update Date | 2024-11-25 |