| NPI | 1720703382 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH DAVIS Owner 667-367-8357 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2022-10-06 |
| Last Update Date | 2023-02-21 |