| NPI | 1790670347 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY MOLLE CEO 888-589-8808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2025-06-12 |
| Last Update Date | 2025-06-12 |