| NPI | 1811512387 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BOBBI JO DURST Provider, Owner 262-260-9000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2024-06-14 |