Individual
GLORIA OMAR JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4926 W BROAD ST, RICHMOND, VA 23230-3122
(804) 673-5241
Mailing address
602 MILTON ST, RICHMOND, VA 23222-2843
(804) 241-7596
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
0002023000
VA
Other
Enumeration date
08/11/2021
Last updated
08/11/2021
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