| NPI | 1700901477 |
|---|---|
| Former Name | LISA LORRAINE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NE 110462) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 54950) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2012-10-18 |