| NPI | 1912782269 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE PORTER Administrator 800-688-0388 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 364SP0810X Clinical Nurse Specialist, Psych/Mental Health, Child & Family |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2023-08-25 |
| Last Update Date | 2023-08-25 |