| NPI | 1770168692 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA DENISE MANCUSO Owner 520-276-6326 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2021-03-11 |
| Last Update Date | 2021-03-11 |