Individual
BRUCE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3322 CHANATE RD, SANTA ROSA, CA 95404-1708
(707) 565-4980
Mailing address
3322 CHANATE RD, SANTA ROSA, CA 95404-1708
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
296785
CA
Other
Enumeration date
12/20/2006
Last updated
07/15/2014
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