Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | APRN.CNP.020386 | OH |
NPI | 1003351024 |
---|---|
Provider Name | Carie Lynn Johnson |
First Address | Waverly, OH 45690-8968 |
Second Address | Waverly, OH 45690-8968 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2016 |
Last Update Date | 29/12/2020 |