Individual
JENNA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
510 N COURT ST, SPARTA, WI 54656-1708
(608) 633-2817
Mailing address
W3193 COUNTY ROAD Q, MINDORO, WI 54644-9118
(608) 386-3811
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
316447-31
WI
Other
Enumeration date
12/27/2012
Last updated
12/27/2012
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