Individual
MRS. JACQUELINE S JOHANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
310 LAFAYETTE AVE SE STE 410, GRAND RAPIDS, MI 49503-4693
(616) 685-8200
(616) 685-8202
Mailing address
310 LAFAYETTE AVE SE STE 410, GRAND RAPIDS, MI 49503-4693
(616) 685-8200
(616) 685-8202
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601008301
MI
Other
Enumeration date
05/23/2005
Last updated
12/28/2021
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