| NPI | 1730894676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATIELA STUCKES Agency Director 980-355-3737 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2023-01-16 |
| Last Update Date | 2025-05-19 |