Individual
MR. JEREMY MICHAEL JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.P.N.
Contact information
Practice address
3401 N 67TH AVE, PHOENIX, AZ 85033-4517
(623) 691-4085
Mailing address
1626 N LOS ALTOS CT, CHANDLER, AZ 85224-8357
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP031774
AZ
Other
Enumeration date
12/13/2007
Last updated
12/13/2007
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