| NPI | 1821789785 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC BENJAMIN HAERTLING Owner 870-598-4075 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 261Q00000X |
| Enumeration Date | 2023-05-19 |
| Last Update Date | 2023-12-21 |