Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 04715 | IA |
N | 207P00000X | Emergency Physician | DO2508 | TN |
NPI | 1013158955 |
---|---|
Provider Name | Brooke Johnson |
First Address | Des Moines, IA 50309-1406 |
Second Address | Des Moines, IA 50309-1406 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2009 |
Last Update Date | 25/07/2016 |