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Organization
ALYSSA JOHNSTON REGISTERED NURSING, INC.
Active
Organization
ALYSSA JOHNSTON REGISTERED NURSING, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB SUNG KEUM MD (ATTENDING PHYSICIAN)
(770) 876-9602
Entity
Organization
Contact information
Practice address
1814 CIRBY WAY APT B, ROSEVILLE, CA 95661-5564
(770) 876-9602
Mailing address
1814 CIRBY WAY APT B, ROSEVILLE, CA 95661-5564
(770) 876-9602
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1215998737
NPI
—
01
—
1891281432
NPI
—
Enumeration date
04/11/2022
Last updated
04/20/2022
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