| NPI | 1902422629 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDRIA LIGHTNING Owner/Operator 260-580-3212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2020-06-18 |
| Last Update Date | 2023-06-15 |