| NPI | 1912518853 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | INGE GISELA BUNDCHEN President 928-899-7784 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2020-08-13 |
| Last Update Date | 2020-08-13 |