| NPI | 1689056285 |
|---|---|
| Former Name | MARY JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: IL 209-013360) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041-359227) |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2021-02-19 |