| NPI | 1881316891 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUCINDA OKYERE AGBEWALI Nurse Practitioner 980-236-9244 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2022-09-15 |
| Last Update Date | 2024-04-16 |