| NPI | 1629380639 |
|---|---|
| Former Name | CANDICE LEANNE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 2998) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 22203) |
| Enumeration Date | 2010-07-07 |
| Last Update Date | 2016-10-04 |