Individual
THERESA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, MS,FNP-BC
Contact information
Practice address
3200 GREENFIELD RD STE 300, DEARBORN, MI 48120-1805
(313) 334-6395
Mailing address
17778 VIOLET DR, SOUTHFIELD, MI 48076-2098
(483) 182-2092
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704285116
MI
363LF0000X
Family Nurse Practitioner
4704285116
MI
Other
Enumeration date
11/24/2014
Last updated
11/04/2022
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