Individual
NICOLE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3116 SW 71ST ST, OKLAHOMA CITY, OK 73159-3612
(405) 205-2185
Mailing address
3116 SW 71ST ST, OKLAHOMA CITY, OK 73159-3612
(405) 205-2185
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
OK
Other
Enumeration date
06/09/2022
Last updated
06/09/2022
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