Individual
LYNNE ALICE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
611 E. VIRGINIA STR., LA VETA, CO 81055
(719) 742-5548
Mailing address
611 EAST VIRGINIA, LA VETA, CO 81055-1033
(719) 742-5548
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
J5667
TX
Other
Enumeration date
02/10/2006
Last updated
03/04/2015
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