Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Family |
363LF0000X | 50 | Nurse Practitioner |
| NPI # | 1124307129 |
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| LBN Legal business name | ACKLEY MEDICAL CENTER | ||||||||
| Authorized official | DARLA NEDERHOFF - (CLINIC MANAGER) | ||||||||
| Entity | Organization | ||||||||
| Organization subpart 1 | Yes | ||||||||
| Enumeration date | 08/08/2011 | ||||||||
| Last updated | 12/03/2020 - About 6 years ago | ||||||||
| Identifiers |
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ACKLEY MEDICAL CENTER
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