| NPI | 1841667672 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA FASHANT-PETERSON CEO 888-592-6117 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 0390) |
| Enumeration Date | 2015-08-27 |
| Last Update Date | 2015-08-27 |