Individual
NICOLE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4225 E UNIVERSITY DR APT 128, MESA, AZ 85205-7092
(719) 321-5099
Mailing address
1361 S GREENFIELD RD APT 1059, MESA, AZ 85206-3391
(719) 321-5099
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
LIC23-07617
AZ
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
04/29/2022
Last updated
02/05/2024
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