| NPI | 1770519530 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCUS ANTONIO DESIO Owner 731-661-1031 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN apn10467) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN tn0000030429) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: TN tn0000030429) | |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2025-09-11 |