| NPI | 1790565232 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAIGE E BURESH Co Owner 531-242-6965 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2023-10-02 |
| Last Update Date | 2024-12-10 |