Individual
MRS. CARMEN E. JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CERTIFIED HAIR LOSS
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
C
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1835X0200X
ONCOLOGY
NC
01
—
207N00000X
DERMATOLOGY
NC
Enumeration date
03/05/2021
Last updated
03/05/2021
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