Individual
LISA R JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
420 COMMUNITY DR STE 1, NORTH LIBERTY, IA 52317-6706
(319) 626-6006
Mailing address
420 COMMUNITY DR STE 1, NORTH LIBERTY, IA 52317-6706
(319) 626-6006
(319) 626-3400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34720
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1242636
—
IA
01
—
37090
WELLMARK
IA
Enumeration date
01/17/2007
Last updated
06/27/2016
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