| NPI | 1891105326 |
|---|---|
| Former Name | LACEY ELIZABETH JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2016-01069) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 201825) |
| Enumeration Date | 2014-05-06 |
| Last Update Date | 2023-11-14 |