| NPI | 1093472219 |
|---|---|
| Former Name | JALEESA JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-182058) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95016628) |
| 363LF0000X Nurse Practitioner, Family (Licence: LA 223825) | |
| Enumeration Date | 2021-11-22 |
| Last Update Date | 2023-02-20 |