Individual
MS. NICHELLE RYNETTE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
44150 W MARICOPA CASA GRANDE HWY, MARICOPA, AZ 85138-5900
(520) 568-5100
Mailing address
19522 N COMET TRL, MARICOPA, AZ 85138-5814
(520) 568-6036
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN044382
AZ
Other
Enumeration date
09/11/2009
Last updated
09/11/2009
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