| NPI | 1750995643 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE GOETZ Owner 270-215-7744 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2020-09-08 |
| Last Update Date | 2023-11-13 |