Individual
MICHELLE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11050 PARKVIEW CIRCLE DR, FORT WAYNE, IN 46845-1739
(833) 724-8326
(260) 425-6845
Mailing address
3702 NEW VISION DR BLDG B, FORT WAYNE, IN 46845-1703
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28221298A
IN
363L00000X
Nurse Practitioner
Primary
71008907A
IN
Other
Enumeration date
02/25/2019
Last updated
04/25/2019
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