| NPI | 1699498907 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUZIE FATOU JACKATEY Owner/Nurse Practitioner 857-999-6122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2022-09-21 |
| Last Update Date | 2024-01-30 |