| NPI | 1811343072 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM BLANCHARD Owner 317-518-8166 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209012388) |
| Enumeration Date | 2016-05-06 |
| Last Update Date | 2016-05-25 |