| NPI | 1750217519 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE DENISE NICKENS CEO 216-315-3980 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363LC1500X Nurse Practitioner, Community Health |
| Enumeration Date | 2026-06-19 |
| Last Update Date | 2026-07-04 |