| NPI | 1295299220 |
|---|---|
| Former Name | JESSICA JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 11001564) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL F011907777) |
| Enumeration Date | 2019-01-23 |
| Last Update Date | 2019-11-04 |