Individual
ELIZABETH JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1235 8TH ST, LAS VEGAS, NM 87701-4219
(505) 425-6788
Mailing address
PO BOX 2985, LAS VEGAS, NM 87701-2985
(484) 619-5088
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA2023-0296
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/28/2022
Last updated
11/22/2023
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