| NPI | 1730860784 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KHYANNE MCCUTCHEN Director/ Np 443-985-6615 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine | |
| Enumeration Date | 2023-07-31 |
| Last Update Date | 2024-10-21 |