NPI | 1346414745 |
---|---|
Former Name | LARA LYN NELSON-JOHNSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11004624) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC 25042) |
363LF0000X Nurse Practitioner, Family (Licence: TN 33103) | |
Enumeration Date | 2008-04-16 |
Last Update Date | 2024-05-08 |