| NPI | 1952790651 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIDA SARKODIE Advanced Nurse Practitioner 862-596-0705 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2015-01-18 |
| Last Update Date | 2015-01-18 |