Individual
LAURIE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
413 N 17TH AVE, WAUSAU, WI 54401-4226
(715) 842-4649
Mailing address
413 N 17TH AVE, WAUSAU, WI 54401-4226
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
5064
WI
Other
Enumeration date
01/22/2009
Last updated
01/22/2009
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