Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Family |
363LF0000X | 50 | Nurse Practitioner |
| NPI # | 1710453014 |
| LBN Legal business name | 1522 ESSENTIAL CARE PC |
| Authorized official | PATRICIA SHORT - (OWNER/PROVIDER) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 10/15/2018 |
| Last updated | 10/15/2018 - About 8 years ago |
| Identifiers | n/a |
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1522 ESSENTIAL CARE PC
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