Individual
MRS. KHALYNE THERYSE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1813 ASHLAND AVE, SHEBOYGAN, WI 53081-6125
(920) 458-4010
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
61556-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100036467
—
WI
Enumeration date
06/20/2012
Last updated
09/09/2024
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