Individual
BEAU WILLIAM JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 S 1000 W, TOOELE, UT 84074-4010
(801) 273-6507
Mailing address
4460 S HIGHLAND DR, SALT LAKE CITY, UT 84124-3543
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
06/05/2018
Last updated
06/05/2018
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