| NPI | 1720717804 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARETH PENTA Owner/Provider 360-559-3456 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2022-06-06 |
| Last Update Date | 2022-10-12 |