| NPI | 1508275603 |
|---|---|
| Former Name | STEPHANIE ERNESTA JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 11653) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 7134-23) |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2025-05-23 |