| NPI | 1396910006 |
|---|---|
| Former Name | NICOLE RAE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MT NUR-APRN-LIC-101298) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MT RN30747) |
| 207P00000X Emergency Medicine (Licence: MT 101298) | |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2024-08-29 |