| NPI | 1700217189 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID SEGRAVES Owner 765-281-8883 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71003894B) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01027232A) |
| Enumeration Date | 2013-12-10 |
| Last Update Date | 2014-02-25 |