| NPI | 1922762665 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH JOHNSON Owner 314-938-4438 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2021-10-28 |
| Last Update Date | 2021-10-28 |