Individual
SHE-RA LATOYA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4329 N 91ST ST, MILWAUKEE, WI 53222-1611
(414) 303-1269
Mailing address
4329 N 91ST ST, MILWAUKEE, WI 53222-1611
(414) 303-1269
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
J5257928790608
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100175329
—
WI
Enumeration date
09/24/2021
Last updated
09/24/2021
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