Individual
BREENA MARIE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
416 CONNABLE AVE, PETOSKEY, MI 49770-2212
(231) 330-4235
Mailing address
790 RED OAK WAY, PETOSKEY, MI 49770-2979
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
5601006233
MI
Other
Enumeration date
01/04/2011
Last updated
01/10/2014
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