| NPI | 1457647976 |
|---|---|
| Former Name | TERESA R JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102203513) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116023887) |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2023-01-05 |