| NPI | 1972702595 |
|---|---|
| Former Name | JILL JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 3927) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-126332) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2026-09-03 |