Individual
ANDREA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
21203 N HART PL, DETROIT, MI 48220-2108
(248) 688-5065
Mailing address
21203 N. HART PL., DETROIT, MI 48220
(248) 688-5065
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703111959
MI
Other
Enumeration date
11/24/2015
Last updated
11/24/2015
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