Individual
MS. ROBERTA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1624 BOISMENUE AVE, CENTREVILLE, IL 62207-2131
(618) 698-3308
Mailing address
1624 BOISMENUE AVE, CENTREVILLE, IL 62207-2131
(618) 698-3308
Taxonomy
Speciality
Code
Description
License number
State
246RP1900X
Phlebotomy Technician
Primary
—
—
Other
Enumeration date
11/19/2021
Last updated
11/19/2021
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