Individual
DETTY THOMAS JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8505 NEWBERRY GROVE DR, APEX, NC 27539-7970
(919) 670-7547
Mailing address
8505 NEWBERRY GROVE DR, APEX, NC 27539-7970
(919) 670-7547
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
251930
NC
Other
Enumeration date
12/06/2017
Last updated
12/06/2017
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