| NPI | 1770110777 |
|---|---|
| Former Name | STEFFANI NICOLE JOHNSTON MACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 14462) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: ND PAC0837) | |
| 363AS0400X Physician Assistant Surgical | |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2023-12-01 |