| NPI | 1184061665 |
|---|---|
| Former Name | RAVEN JEANINE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q9823) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036138911) |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2023-07-06 |