| NPI | 1992541890 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMILY DEROCCO Secretary 620-504-2434 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology |
| Enumeration Date | 2024-07-01 |
| Last Update Date | 2025-04-28 |