Individual
OLIVIA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1300 N 12TH ST STE 508, PHOENIX, AZ 85006-2849
(602) 839-3927
Mailing address
1111 E MCDOWELL RD, PHOENIX, AZ 85006-2612
(602) 839-3644
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
16652A
WY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/11/2021
Last updated
09/16/2024
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