| NPI | 1982168407 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW D RICHARDSON Nurse Practitioner 773-732-6427 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2019-01-29 |