| NPI | 1417338211 |
|---|---|
| Former Name | STEPHANIE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: PA MD475007) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MO 2015018578) |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2021-09-28 |