Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 53932 | CO |
NPI | 1083888937 |
---|---|
Provider Name | Dr. Katherine Mirro Johnson |
First Address | Wheat Ridge, CO 80034-1449 |
Second Address | Wheat Ridge, CO 80033-4880 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2008 |
Last Update Date | 03/03/2020 |