| NPI | 1790583557 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELODEE JONAS Office Manager 719-301-0133 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2025-03-06 |
| Last Update Date | 2025-03-06 |