| NPI | 1770606477 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN STALLWOOD Affiliate Administrator 239-262-8923 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LW0102X Nurse Practitioner, Women's Health |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2020-08-22 |