Individual
THORNELL JOHNSON I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
906 HICKORY CIR, LA PLATA, MD 20646-3213
(240) 715-2852
Mailing address
906 HICKORY CIR, LA PLATA, MD 20646-3213
(240) 715-2852
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP53308
MD
Other
Enumeration date
05/17/2025
Last updated
05/17/2025
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