| NPI | 1912528985 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK WINEBRENER Owner 985-351-4776 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery |
| 207Y00000X Otolaryngology | |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2020-04-30 |
| Last Update Date | 2020-04-30 |