Individual
FANFORDA OLIVIA MACJOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2512 24TH ST NE, WASHINGTON, DC 20018-2126
(202) 832-8340
Mailing address
9701 AVIS CT, UPPER MARLBORO, MD 20774-2281
(301) 442-9891
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN67224
DC
Other
Enumeration date
10/20/2022
Last updated
10/20/2022
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