Individual
ALICIA KATHERINE JOHNSON
Active
Individual
ALICIA KATHERINE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP,
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
MA00024163
WA
Other
Enumeration date
06/09/2008
Last updated
05/01/2012
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