| NPI | 1992451744 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARILYN ANN STAIRES Provider, Owner 401-480-5544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2022-03-01 |
| Last Update Date | 2022-03-03 |