| NPI | 1356833941 |
|---|---|
| Former Name | KEISHA MARIE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209017366) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2018005309) |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2023-07-10 |