Individual
LARRY R JOHNSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
5011 STATE RD, FORT GRATIOT, MI 48059-2909
(810) 300-3696
Mailing address
5011 STATE RD, FORT GRATIOT, MI 48059-2909
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704277488
MI
Other
Enumeration date
12/16/2018
Last updated
12/16/2018
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