Individual
ELIZABETTE GUERRETTAZ JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
8414 NAAB ROAD, SUITE 120, INDIANAPOLIS, IN 46260
(317) 338-7510
(317) 338-7494
Mailing address
8414 NAAB RD, INDIANAPOLIS, IN 46260-1972
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11019424A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11019424A
INDIANA MEDICAL LICENSE
IN
Enumeration date
03/27/2017
Last updated
07/01/2022
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