| NPI | 1982422564 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL MCNALLY CEO 986-200-6219 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2024-10-01 |
| Last Update Date | 2024-10-18 |