Individual
MS. KRYSTAL MICHELE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
31 OAKLAND AVE, SUITE 1B, PONTIAC, MI 48342-2019
(248) 758-9813
(248) 758-9815
Mailing address
31 OAKLAND AVE, SUITE 1B, PONTIAC, MI 48342-2019
(248) 758-9813
(248) 758-9815
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
5681890001
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4641944
—
MI
Enumeration date
03/19/2007
Last updated
07/09/2007
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