| NPI | 1720485659 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE WIERSMA CEO 440-233-0159 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207QA0505X Family Medicine, Adult Medicine | |
| 207R00000X Internal Medicine | |
| 207V00000X Obstetrics & Gynecology | |
| 208000000X Pediatrics | |
| 363L00000X Nurse Practitioner | |
| 363LP0200X Nurse Practitioner, Pediatrics | |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2014-11-20 |
| Last Update Date | 2014-11-20 |