| NPI | 1861057036 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LLATOYA GAYLE Credentialing Specialist 475-210-5346 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 207X00000X Orthopaedic Surgery | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2019-05-03 |
| Last Update Date | 2019-05-03 |