| NPI | 1760148290 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAURICE BUNNELL Authorized Official 475-202-3318 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2021-11-09 |
| Last Update Date | 2022-02-09 |