| NPI | 1922463926 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MALCOLM LEAL CASTANEDA Manager 308-675-1931 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NE 110175) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NE 39208) |
| Enumeration Date | 2015-12-18 |
| Last Update Date | 2015-12-18 |