Individual
ANTWONE JOHNSON SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
9605 GRAND RIVER AVE, DETROIT, MI 48204-2139
(313) 834-5930
Mailing address
3851 MCCLELLAN ST, DETROIT, MI 48214-1311
(313) 829-2557
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703110366
MI
Other
Enumeration date
04/04/2013
Last updated
04/04/2013
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