NPI | 1497025647 |
---|---|
Former Name | LAUREN GABRIELLE JOHNSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024169665) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0001223115) |
Enumeration Date | 2012-01-05 |
Last Update Date | 2023-03-07 |