| NPI | 1720619091 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | QUIN CONLEY Credentialing 313-587-6380 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2020-01-27 |
| Last Update Date | 2020-02-26 |