| NPI | 1962803270 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA MARIE MRZENA Clinical Director 907-301-6668 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 251S00000X (Licence: UT 6593775-4405) |
| Enumeration Date | 2014-09-07 |
| Last Update Date | 2021-06-16 |