| NPI | 1750677407 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN L JACKSON Owner 251-533-6372 |
| Organization Subpart ? | No |
| Primary Taxonomy | 364SG0600X Clinical Nurse Specialist, Gerontology (Licence: AL 1-087343) |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2011-12-30 |