Individual
JENNIFER MYIA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2880 FOLSOM ST STE 100, BOULDER, CO 80304-3769
(303) 327-7047
(303) 443-7168
Mailing address
PO BOX 1628, LONGMONT, CO 80502-1628
(303) 651-5139
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
43964
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
56929340
—
CO
Enumeration date
03/28/2007
Last updated
03/07/2023
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