| NPI | 1881154847 |
|---|---|
| Former Name | CAROL EILEEN JOHANSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61293717) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2019-03-24 |
| Last Update Date | 2023-07-27 |