| NPI | 1699148254 |
|---|---|
| Former Name | JENNA MARISSA JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA53083) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9113166) |
| 363AM0700X Physician Assistant, Medical (Licence: NV PA2873) | |
| Enumeration Date | 2015-11-04 |
| Last Update Date | 2023-12-13 |