| NPI | 1720662455 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NINA C. LANE Nurse Practitioner 866-472-6288 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family |
| 363LP2300X Nurse Practitioner Primary Care | |
| Enumeration Date | 2021-05-10 |
| Last Update Date | 2022-09-02 |