| NPI | 1962925495 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL MOGREN Practice Administrator 315-391-6645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F302363-1) |
| Enumeration Date | 2017-07-17 |
| Last Update Date | 2017-07-17 |