Individual
PENNY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
106 W NORTH ST, CORTEZ, CO 81321-3119
(970) 565-3056
(970) 565-0647
Mailing address
27241 ROAD T.5, DOLORES, CO 81323-9415
(970) 882-7463
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
31704
CO
Other
Enumeration date
03/06/2007
Last updated
07/08/2007
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