| NPI | 1861062267 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NO ONE Owner 702-555-1212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Additional Taxonomies | 251S00000X |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2021-06-28 |
| Last Update Date | 2022-01-12 |