| NPI | 1790257855 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACI CHURCH Owner 410-713-8804 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2018-12-28 |
| Last Update Date | 2025-04-24 |