Individual
LAURA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
18051 RIVER RD STE 200, NOBLESVILLE, IN 46062-7092
(317) 773-0002
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01042877
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200034340
—
IN
Enumeration date
08/16/2006
Last updated
08/24/2018
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