Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 9679 | NM |
NPI | 1245324623 |
---|---|
Provider Name | Dianne Johnson |
First Address | Albuquerque, NM 87125-6666 |
Second Address | Espanola, NM 87532-2724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 17/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E57796 | (02) | |
H5234 | (05) | NM |