Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2005019610 | MO |
Y | 2080P0204X | Pediatric Emergency Doctor | DR.0050433 | CO |
NPI | 1013180348 |
---|---|
Provider Name | Bernadette Kathleen Johnson |
First Address | Aurora, CO 80042-0429 |
Second Address | Aurora, CO 80045-7106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2008 |
Last Update Date | 05/12/2018 |