Individual
TYREYUN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
235 CENTRAL AVE, EDGARD, LA 70049-2533
(504) 413-1099
Mailing address
235 CENTRAL AVE, EDGARD, LA 70049-2533
(504) 413-1099
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
—
—
Other
Enumeration date
05/30/2019
Last updated
05/30/2019
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