Organization
ANNOINTED OUTREACH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAZON JOHNSON (ADMINISTRATOR)
(248) 221-5469
Entity
Organization
Contact information
Practice address
1175 BALDWIN AVE, PONTIAC, MI 48340-2709
(248) 221-5469
Mailing address
1175 BALDWIN AVE, PONTIAC, MI 48340-2709
(248) 221-5469
Taxonomy
Speciality
Code
Description
License number
State
364SA2200X
Adult Health Clinical Nurse Specialist
Primary
—
—
Other
Enumeration date
05/08/2019
Last updated
10/07/2021
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