| NPI | 1912511981 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE LUNGELOW Pmhnp 910-502-3787 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2020-09-07 |
| Last Update Date | 2020-09-07 |