Individual
MRS. EVELYN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
542 4TH AVE, STE. 234, FAIRBANKS, AK 99701-4714
(907) 456-4524
(907) 456-5524
Mailing address
4016 SPRUCE ST APT 4, FT WAINWRIGHT, AK 99703-1112
(907) 456-4524
(907) 456-5524
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
272340
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CM4322
—
AK
Enumeration date
03/14/2007
Last updated
07/09/2007
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