| NPI | 1720599657 |
|---|---|
| Other Name | MH 102, PC AT NCR |
| Entity Type | Organization |
| Authorized Contact | TERRY LAYMAN Corporate Medical Officer 317-727-8698 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2017-10-18 |
| Last Update Date | 2022-11-23 |