Individual
THERESE ANN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3267 S 16TH STREET, EMS OFFICE, MILWAUKEE, WI 53215
(414) 647-5203
(414) 647-5203
Mailing address
6053 N SHORELAND AVE, WHITEFISH BAY, WI 53217-4662
(414) 962-0945
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
674-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
674-023
WISCONSIN STATE LICENSE
WI
Enumeration date
06/14/2006
Last updated
11/27/2023
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