| NPI | 1508228453 |
|---|---|
| Former Name | SHANIQUA CHANTEL JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0207X Pediatrics Pediatric Hematology-Oncology (Licence: TX T6270) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125068492) |
| 208000000X Pediatrics (Licence: TX T6270) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2022-08-19 |