Individual
MAKAYLA ROSE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17001 N ANGLER CLUB RD, GASTON, IN 47342-9225
(765) 702-7167
Mailing address
17001 N ANGLER CLUB RD, GASTON, IN 47342-9225
(765) 702-7167
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
IN
Other
Enumeration date
02/09/2017
Last updated
02/09/2017
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