Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 65969 | WI |
Y | 207V00000X | Obstetrician & Gynecologist | DR.0062392 | CO |
N | 207V00000X | Obstetrician & Gynecologist | MD.207295 | LA |
NPI | 1013233105 |
---|---|
Provider Name | Amanda Jean Johnson |
First Address | Aurora, CO 80042-0429 |
Second Address | Aurora, CO 80045-2545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2010 |
Last Update Date | 16/08/2019 |