| NPI | 1841079407 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOLORES IMELDA VAN BOURGONDIEN Director 207-200-7518 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| Enumeration Date | 2023-09-25 |
| Last Update Date | 2024-10-11 |