| NPI | 1770255291 |
|---|---|
| Doing Business As | SELF |
| Entity Type | Organization |
| Authorized Contact | DONNA BOATMAN Credentialing Manager 301-399-6874 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2021-10-03 |
| Last Update Date | 2022-12-19 |