| NPI | 1710359179 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEISHA BURRELL Np 347-409-6288 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 33-3372244) |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2015-10-26 |
| Last Update Date | 2021-11-08 |