| NPI | 1881206589 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL J BAKER Owner 757-381-6655 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2020-08-24 |
| Last Update Date | 2024-02-27 |