| NPI | 1962834705 |
|---|---|
| Former Name | KOLEENA MARIE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MN CNP3069) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R171916-7) |
| Enumeration Date | 2013-08-03 |
| Last Update Date | 2024-10-31 |