Individual
WAYNE CLAIR JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3115 N GOVT WAY, SUITE #7, COEUR D ALENE, ID 83815-3790
(208) 762-0797
(208) 762-0791
Mailing address
3115 N GOVERNMENT WAY, SUITE #7, COEUR D ALENE, ID 83815
(208) 762-0797
(208) 762-0791
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8053443
—
ID
Enumeration date
11/13/2006
Last updated
01/24/2012
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