Individual
MRS. WANDA SUE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RMF/CMF
Contact information
Practice address
4228 GARRETT RD, DURHAM, NC 27707-3430
(919) 489-7408
(919) 490-5909
Mailing address
4228 GARRETT RD, DURHAM, NC 27707-3430
(919) 489-7408
(919) 490-5909
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7795110
—
NC
Enumeration date
04/03/2007
Last updated
07/11/2007
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