| NPI | 1699271726 |
|---|---|
| Former Name | AMANDA LYNN JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: IL 125073455) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME165822) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-05 |
| Last Update Date | 2023-11-30 |