| NPI | 1922827542 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | K-SHAYLA LAFAYETTE Nurse Practitioner/Manager 815-908-9685 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2024-10-09 |
| Last Update Date | 2024-10-09 |