| NPI | 1962229039 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATRICE MARIE WADDELL Advanced Practice Registered Nurse 419-508-9937 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-09-20 |
| Last Update Date | 2024-09-20 |