| NPI | 1922604644 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA FRITH Owner 432-704-1058 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2020-12-08 |
| Last Update Date | 2020-12-08 |