Individual
PORTIA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12250 W NORTH AVE, MILWAUKEE, WI 53226-2063
(414) 882-7881
Mailing address
5835 N 36TH ST, MILWAUKEE, WI 53209-4009
(414) 865-6622
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
02/13/2023
Last updated
02/13/2023
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