Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 163WA0400X | Registered Nurse | Addiction (Substance Use Disorder) | | | No |
| 2 | 163WW0000X | Registered Nurse | Wound Care | | | No |
| 3 | 2083A0300X | Preventive Medicine | Addiction Medicine | | | No |
| 4 | 261QC1500X | Clinic/Center | Community Health | | | No |
| 5 | 261QM1300X | Clinic/Center | Multi-Specialty | | | Yes |
| 6 | 261QX0100X | Clinic/Center | Occupational Medicine | | | No |
| 7 | 332B00000X | Durable Medical Equipment & Medical Supplies | | | | No |
| 8 | 363L00000X | Nurse Practitioner | | | | No |
| 9 | 363LP0808X | Nurse Practitioner | Psychiatric/Mental Health | | | No |
| 10 | 363LP2300X | Nurse Practitioner | Primary Care | | | No |
| 11 | 363LX0106X | Nurse Practitioner | Occupational Health | | | No |