Individual
DIANE NICOLE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
15510 W BELL RD, SURPRISE, AZ 85374-3436
(623) 584-8593
Mailing address
15510 W BELL RD, SURPRISE, AZ 85374-3436
(623) 584-8593
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5728
AZ
Other
Enumeration date
12/02/2011
Last updated
07/18/2014
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