| NPI | 1881456275 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RASHONDA RENEE WILSON Nurse Practitioner 980-333-9105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-01-30 |
| Last Update Date | 2024-01-30 |