| NPI | 1891303368 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT JOHNSON Np 606-451-9748 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology |
| Enumeration Date | 2020-07-21 |
| Last Update Date | 2020-07-21 |