| NPI | 1861877052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUALINE GERVAIS Owner 218-477-1353 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN CNP3899) |
| Enumeration Date | 2015-07-29 |
| Last Update Date | 2023-01-17 |