Individual
MRS. ALZA THERESA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
139 CLYDE AVE, SYRACUSE, NY 13207
(315) 200-7203
Mailing address
139 CLYDE AVE, SYRACUSE, NY 13207
(315) 200-7203
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
299068-1
NY
Other
Enumeration date
06/13/2016
Last updated
06/13/2016
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