| NPI | 1952912644 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISHA C FALK VP Of Contracting 337-609-1221 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2020-08-14 |
| Last Update Date | 2022-03-23 |