Individual
DETRIC D JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
535 WYOMING AVE STE 1, BUFFALO, NY 14215-3137
(716) 253-1847
(716) 845-3511
Mailing address
535 WYOMING AVE STE 1, BUFFALO, NY 14215-3137
(716) 253-1847
(716) 845-3511
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
NY
Other
Enumeration date
07/10/2018
Last updated
06/06/2019
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