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 |