| NPI | 1336687458 |
|---|---|
| Former Name | ANNA MARIE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 13349) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MN 5601008125) |
| 363AM0700X Physician Assistant, Medical (Licence: MI 5601008125) | |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2021-03-04 |