| NPI | 1811312788 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA LORENZO Manager 502-269-9772 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2014-02-28 |
| Last Update Date | 2021-09-17 |