Individual
BRIDGET RENEE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
20090 210TH AVE, TUSTIN, MI 49688-8210
(231) 829-5095
Mailing address
20090 210TH AVE, TUSTIN, MI 49688-8210
(231) 829-5095
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
AF670251586
MI
Other
Enumeration date
01/02/2012
Last updated
01/02/2012
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