Individual
JENNIFER M JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1035 ALTO STREET, SANTA FE, NM 87501
(505) 982-4425
(505) 982-6280
Mailing address
1035 ALTO ST, SANTA FE, NM 87501-2406
(505) 982-4425
(505) 982-6280
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
87-268
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00003202
—
NM
Enumeration date
07/17/2006
Last updated
07/08/2007
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