Individual
TRACI LYNN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
71 MDG, 527 GOTT RD, VANCE AFB, OK 73705-5105
(580) 213-7909
Mailing address
71 MDG, 527 GOTT RD, VANCE AFB, OK 73705-5105
(580) 213-7909
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
55339
OK
Other
Enumeration date
02/17/2009
Last updated
02/17/2009
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