NPI | 1730602376 |
---|---|
Former Name | HAYLEY RAE JOHNSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA57700) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA18331) |
Enumeration Date | 2017-07-25 |
Last Update Date | 2025-08-25 |