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Individual

MS. JENNIFER ANN JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
4102 PINION DR, US AIR FORCE, CO 80840-2502
(719) 333-5041
Mailing address
4102 PINION DR, USAF ACADEMY, CO 80840-2502
(719) 333-5041

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
1470-023
WI
363AS0400X
Surgical Physician Assistant
Primary
PA.0004517
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
41960600
WI
Enumeration date
05/20/2006
Last updated
11/22/2024
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