| NPI | 1801625926 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTINA EZIGBO Administrator 346-220-3534 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-07-29 |
| Last Update Date | 2025-04-23 |