| NPI | 1942908116 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AL BERRY Credentialing Manager 800-000-0000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-02-17 |
| Last Update Date | 2023-02-17 |