Individual
DEDRICK JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2211 LOMAS BLVD NE, ALBUQUERQUE, NM 87106-2719
(505) 272-2111
Mailing address
PO BOX 15442, RIO RANCHO, NM 87174-0442
(254) 251-6013
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
82229
NM
363LP2300X
Primary Care Nurse Practitioner
82229
NM
Other
Enumeration date
01/06/2025
Last updated
04/14/2025
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