Individual
LAKREESE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
3855 COOPER ST, JACKSON, MI 49201-7547
(517) 780-5991
Mailing address
3855 COOPER ST, JACKSON, MI 49201-7547
(517) 780-5991
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
5601005679
MI
363AM0700X
Medical Physician Assistant
Primary
5601005679
MI
Other
Enumeration date
06/06/2010
Last updated
12/13/2017
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