| NPI | 1972383354 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINA MUSIC Director, Provider Enrollment 877-892-9815 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery |
| 367A00000X Advanced Practice Midwife | |
| 208800000X Urology | |
| 363AS0400X Physician Assistant Surgical | |
| 363LA2200X Nurse Practitioner Adult Health | |
| Enumeration Date | 2023-10-03 |
| Last Update Date | 2024-07-11 |