| NPI | 1790536142 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDY DIVINE Owner 417-296-4140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine |
| Enumeration Date | 2024-04-01 |
| Last Update Date | 2024-04-01 |