Individual
THERESA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1305 N 2ND ST, ISHPEMING, MI 49849-1147
(906) 361-6165
Mailing address
1305 N 2ND ST, ISHPEMING, MI 49849-1147
(906) 361-6165
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703095306
MI
Other
Enumeration date
02/28/2018
Last updated
02/28/2018
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