Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 432581 | KS |
NPI | 1033301510 |
---|---|
Provider Name | Dr. Colleen Nicole Johnson |
First Address | Lees Summit, MO 64064-1996 |
Second Address | Kansas City, MO 64154-1465 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2007 |
Last Update Date | 10/03/2017 |