| NPI | 1750672390 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE PRIVITOR PRIVITOR DAVIS Owner 318-816-5116 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA APO5002) |
| Enumeration Date | 2011-05-01 |
| Last Update Date | 2021-07-07 |