| NPI | 1851902159 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIDJETT R GASSAWAY CEO 219-237-0503 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2020-08-11 |
| Last Update Date | 2024-01-18 |