Individual
TANJA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
11133 DUNN RD, SAINT LOUIS, MO 63136-6163
(314) 800-6528
Mailing address
5 MCCLUER CT, O FALLON, MO 63368-1503
(314) 800-6528
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
2014036364
MO
363LF0000X
Family Nurse Practitioner
Primary
2014036364
MO
Other
Enumeration date
10/14/2014
Last updated
09/16/2021
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