Individual
LARA ELIZABETH JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
13203 LADYBANK LN, HERNDON, VA 20171-4031
(580) 251-0082
Mailing address
13203 LADYBANK LN, HERNDON, VA 20171-4031
(580) 251-0082
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
110003747
VA
363A00000X
Physician Assistant
667
AK
363A00000X
Physician Assistant
PA05335
TX
Other
Enumeration date
07/27/2006
Last updated
05/31/2012
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