Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 161571 | AK |
NPI | 1134581226 |
---|---|
Provider Name | Angene Johnson |
First Address | Anchorage, AK 99503-5933 |
Second Address | Anchorage, AK 99503-5933 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2016 |
Last Update Date | 30/11/2021 |