| NPI | 1730940263 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHELLE ADEGBITE-MARAVENTANO Owner 267-594-8734 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| 363LF0000X Nurse Practitioner, Family | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2024-01-22 |
| Last Update Date | 2024-01-22 |