Individual
SIMIRA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
15474 N HAGGERTY RD, PLYMOUTH, MI 48170-4893
(734) 335-6103
(734) 404-5317
Mailing address
901 MCCLINTOCK DR, SUITE 202, BURR RIDGE, IL 60527-0871
(888) 220-6432
(630) 734-4715
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704239161
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235125717
—
MI
Enumeration date
07/15/2014
Last updated
12/11/2014
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