| NPI | 1780143750 |
|---|---|
| Former Name | KATELYN ROSE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0102206346) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2023-08-14 |