| NPI | 1780460006 |
|---|---|
| Doing Business As | A LIFE RENEWED |
| Entity Type | Organization |
| Authorized Contact | BRAD GIBSON CEO/Owner 937-280-5711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-09-01 |
| Last Update Date | 2024-01-24 |