| NPI | 1861456287 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA KING Director, Credentialing Enrollment 800-370-3651 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: AR R32353) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2017-07-11 |