| NPI | 1720791437 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANITA CHANDRA Vice President 618-303-5360 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363LF0000X Nurse Practitioner, Family | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2022-12-28 |
| Last Update Date | 2024-08-02 |