| NPI | 1881886034 |
|---|---|
| Former Name | LAUREN KRISTEN JOHANSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00184000) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00184000) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MD053030) | |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2016-05-18 |