Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 13641R | LA |
NPI | 1003808346 |
---|---|
Provider Name | Dr. Carmen Elizabeth Johnson |
First Address | Opelousas, LA 70570-0775 |
Second Address | Opelousas, LA 70570-0775 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
13641R | STATE LICENSE NUIMBER (01) | LA |
1434108 | (05) | LA |
1449687 | (05) | LA |
H29749 | (02) |