| NPI | 1154968667 |
|---|---|
| Former Name | SAMANTHA MICHELLE JOHNSON |
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704311772) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704311772) |
| Enumeration Date | 2019-12-03 |
| Last Update Date | 2023-11-02 |