NPI | 1154763050 |
---|---|
Former Name | MICHELLE RENAE-PIPPEL JOHNSTON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR PA173678) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
Enumeration Date | 2013-07-22 |
Last Update Date | 2021-01-14 |