| NPI | 1760096135 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETHANY LAQUELL ELLIS Owner/Nurse Practitionerr 754-444-9173 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2020-09-03 |
| Last Update Date | 2026-04-28 |