| NPI | 1558977249 |
|---|---|
| Former Name | SAVANNAH NICOLE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD43692) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AL L.5323R) |
| Enumeration Date | 2020-09-18 |
| Last Update Date | 2024-05-09 |