| NPI | 1710341219 |
|---|---|
| Former Name | DEMARCQUANAEE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 320567) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 302773) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2025-04-17 |