| NPI | 1699470419 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY DIAGO Member 725-910-3725 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2024-04-03 |