Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 95014526 | CA |
NPI | 1013349919 |
---|---|
Provider Name | Casey Lynn Johnson |
First Address | Fallbrook, CA 92028-4006 |
Second Address | Oceanside, CA 92054-3406 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2013 |
Last Update Date | 30/07/2020 |