| NPI | 1417318155 |
|---|---|
| Former Name | JESSICA RUTH JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: DC RN1039813) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: VA 0024173380) |
| Enumeration Date | 2016-03-08 |
| Last Update Date | 2021-08-31 |