Individual
WANDA JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4101 S 4TH ST, LEAVENWORTH, KS 66048-5014
(913) 758-9600
Mailing address
401 NW HEADY AVE, FERRELVIEW, MO 64163-1413
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA00405
TX
Other
Enumeration date
03/24/2006
Last updated
11/04/2007
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