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Individual
MADDIE JOHNSON
Active
Individual
MADDIE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
68225
MT
363AM0700X
Medical Physician Assistant
PA587
WY
363AM0700X
Medical Physician Assistant
PT587
WY
363AM0700X
Medical Physician Assistant
TL587
WY
Other
Enumeration date
12/30/2013
Last updated
04/05/2024
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