Individual
MS. JOHNNIE LAURAETTA FANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
7400 MERTON MINTER ST, SAN ANTONIO, TX 78229-4404
(210) 617-5300
(210) 949-3452
Mailing address
707 SINGING WIND DR, SAN ANTONIO, TX 78227-1028
(210) 617-5300
(210) 949-3452
Taxonomy
Speciality
Code
Description
License number
State
374T00000X
Religious Nonmedical Nursing Personnel
Primary
221594
TX
Other
Enumeration date
09/02/2006
Last updated
07/08/2007
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