| NPI | 1952929119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATASHA B GRAY Ap RN 708-717-0043 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2020-07-13 |
| Last Update Date | 2020-09-21 |