NPI | 1861944696 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: LA 2203782723) |
Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: LA 960733) |
Enumeration Date | 2016-10-27 |
Last Update Date | 2024-03-06 |