| NPI | 1881337632 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LASHAWNDA HOLLAND Credentialing Manager 855-255-1750 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363LA2100X Nurse Practitioner, Acute Care | |
| 363LA2200X Nurse Practitioner, Adult Health | |
| 363LF0000X Nurse Practitioner, Family | |
| 363LG0600X Nurse Practitioner, Gerontology | |
| Enumeration Date | 2022-04-19 |
| Last Update Date | 2022-04-19 |