NPI | 1780136820 |
---|---|
Former Name | KEENA JOHNSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 163WW0101X Registered Nurse, Women's Health Care, Ambulatory (Licence: CA 95003776) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 634327) |
Enumeration Date | 2016-10-25 |
Last Update Date | 2025-08-07 |