Individual
LANIE E JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 955-0350
(414) 805-6864
Mailing address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 955-0350
(414) 805-6864
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4853
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1639665763
—
WI
Enumeration date
07/01/2018
Last updated
03/22/2023
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