Individual
FA-TIA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
5566 N 37TH ST, MILWAUKEE, WI 53209-4734
(414) 324-8479
Mailing address
5566 N 37TH ST, MILWAUKEE, WI 53209-4734
(414) 324-8479
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
198325-30
WI
363L00000X
Nurse Practitioner
Primary
CNP-03357
NM
Other
Enumeration date
12/03/2013
Last updated
10/17/2017
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