| NPI | 1811570112 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVEDA JUNE GRAHAM Chief Medical Officer 267-588-2328 |
| Organization Subpart ? | No |
| Primary Taxonomy | 163WC1500X Registered Nurse Community Health |
| Additional Taxonomies | 363LC1500X Nurse Practitioner Community Health |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2022-02-07 |