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Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Multi-Specialty |
261QM1300X | 70 | Clinic or Group Practice |
| NPI Number | 1114246576 |
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| LBN Legal business name | AVERA MCKENNAN | ||||
| Authorized official | JULIE NORTON - (VP/CFO) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 05/25/2010 | ||||
| Last updated | 07/20/2010 - About 16 years ago | ||||
| Identifiers |
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AVERA MCKENNAN
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AVERA MCKENNAN