| NPI | 1801645692 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER STOUT Manager 337-315-7927 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care |
| 261QU0200X Clinic/Center, Urgent Care | |
| Enumeration Date | 2024-05-15 |
| Last Update Date | 2024-05-24 |