| NPI | 1821741513 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA IVES CEO 381-704-3836 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363LC1500X Nurse Practitioner, Community Health |
| 363LF0000X Nurse Practitioner, Family | |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2022-02-02 |
| Last Update Date | 2024-10-28 |