Organization
JEREMIAH JOHNSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEREMIAH ALAN JOHNSON (LICENSED PRACTICAL NURSE)
(414) 429-7880
Entity
Organization
Contact information
Practice address
3035 W WISCONSIN AVE APT 205, MILWAUKEE, WI 53208-3987
(414) 429-7880
Mailing address
3035 W WISCONSIN AVE APT 205, MILWAUKEE, WI 53208-3987
(414) 429-7880
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
311777-031
WI
Other
Enumeration date
02/01/2010
Last updated
02/01/2010
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