Individual
TARA DENISE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
1749 E FREMONT RD, PHOENIX, AZ 85042-5740
(602) 275-9503
Mailing address
1749 E FREMONT RD, PHOENIX, AZ 85042-5740
(602) 275-9503
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
724089
AZ
Other
Enumeration date
11/19/2010
Last updated
11/19/2010
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