| NPI | 1073818795 |
|---|---|
| Former Name | ELIZABETH DENISE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 528) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 01530) |
| Enumeration Date | 2011-01-12 |
| Last Update Date | 2023-10-26 |