| NPI | 1770187163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN NEWBERRY Manager 385-454-5027 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2020-11-25 |
| Last Update Date | 2025-01-17 |