| NPI | 1710477807 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRED M ITVELDT A RN P 509-707-8581 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60451837) |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2022-09-28 |