Individual
CARLI JEAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-3100
(262) 532-9584
Mailing address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-3100
(262) 532-9584
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7613
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100261551
—
WI
Enumeration date
06/22/2020
Last updated
02/06/2024
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