NPI | 1346218443 |
---|---|
Former Name | SKYE J JOHNSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA170083) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 9999) |
Enumeration Date | 2006-03-14 |
Last Update Date | 2014-10-23 |