| NPI | 1194277152 |
|---|---|
| Former Name | MICHELLE PENDORA JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MD R160398) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R160398) |
| Enumeration Date | 2016-10-25 |
| Last Update Date | 2023-01-26 |