| NPI | 1750791174 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANA MORRIS-BLAKE Manager 866-239-5133 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO 4933) |
| Enumeration Date | 2014-05-07 |
| Last Update Date | 2022-01-25 |