| NPI | 1265470447 |
|---|---|
| Former Name | JUDY JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MN 9616) |
| 363AM0700X Physician Assistant Medical (Licence: ND 0325) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2022-08-04 |