Individual
HEATHER L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1821 S WEBSTER AVE, GREEN BAY, WI 54301-2253
(920) 496-4700
(920) 496-4705
Mailing address
PO BOX 19070, PREVEA HEALTH, GREEN BAY, WI 54307-9070
(920) 496-4700
(920) 496-4705
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2085-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2085-023
PA LICENSE
WI
Enumeration date
01/08/2007
Last updated
07/08/2007
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