| NPI | 1710176912 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDI GLASER Practice Manager 772-344-3702 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0017001266) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA NP0024165998) |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2007-10-24 |