Individual
MRS. ANNIE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
708 E WYTHE CREEK CT STE 103, KUNA, ID 83634-5005
(208) 922-5130
(208) 922-5132
Mailing address
PO BOX 68, KUNA, ID 83634-0068
(208) 922-5130
(208) 922-5132
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-777
ID
Other
Enumeration date
10/09/2008
Last updated
12/01/2010
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