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 |