| NPI | 1013097328 |
|---|---|
| Former Name | EVANGELINE M JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.003179RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-002688) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2022-01-06 |