Individual
MARY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3817 BELLE VIS, SOUTH BEND, IN 46619-2944
(574) 217-2770
Mailing address
3817 BELLE VIS, SOUTH BEND, IN 46619-2944
(574) 217-2770
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
—
—
344600000X
Taxi
—
—
347B00000X
Bus
—
—
347C00000X
Private Vehicle
Primary
—
—
Other
Enumeration date
10/20/2023
Last updated
10/20/2023
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