| NPI | 1700816261 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY CARSON Manager, Payer Enrollment 234-312-5691 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RI0200X Internal Medicine Infectious Disease |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2025-04-10 |