Doctor Name: | MARIE DENISE JOHNSON |
NPI Number: | 1487743902 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP-C |
License Number: | 4704210564 |
Business Practice Address: | 107 N Bridge St Saranac, MI - 488815121 |
Business Phone Number: | 6166429408 |
Business Fax Number: | 6166426940 |
Mailing Address: | 107 N Bridge St, SARANAC |
State: | MI |
Postal Code: | 488815121 |
Phone Number: | 6166429408 |
Fax Number: | 6166426940 |
NPI Enumeration Date: | 10/12/2006 |
NPI Last Update Date: | 10/15/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 4704210564 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |