| NPI | 1831940709 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY DIAGO CEO 725-910-3725 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2024-03-28 |
| Last Update Date | 2024-04-03 |