| NPI | 1972718187 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE L CHESNUTT Bookkeeper 334-281-6363 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 201793) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-041326) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2007-12-18 |