| NPI | 1710266473 |
|---|---|
| Former Name | BRENDA LENAE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: SD CP000650) |
| Enumeration Date | 2011-08-12 |
| Last Update Date | 2016-02-03 |