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 |