| NPI | 1992940266 |
|---|---|
| Former Name | JOHANNA LAINE CHELCUN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 2578) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2008-12-15 |
| Last Update Date | 2022-12-07 |