Individual
CHANNEL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
911 N BUFFALO DR UNIT 210, LAS VEGAS, NV 89128-0381
(702) 932-3500
Mailing address
911 N BUFFALO DR UNIT 210, LAS VEGAS, NV 89128-0381
(702) 932-3500
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1602607309
ID
NV
Enumeration date
11/05/2019
Last updated
11/05/2019
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