| NPI | 1710694468 |
|---|---|
| Doing Business As | WELLSPACE PSYCHIATRY |
| Entity Type | Organization |
| Authorized Contact | THOMAS J FEDERER Owner/Administrator 502-419-4289 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2022-11-02 |
| Last Update Date | 2023-07-25 |