Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 33459 | CO |
NPI | 1063462125 |
---|---|
Provider Name | Christina Louise Johnson |
First Address | Denver, CO 80220-5712 |
Second Address | Wheat Ridge, CO 80033-6005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 18/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01334598 | (05) | CO |