Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | E-1554 | AR |
N | 207ND0101X | MOHS-Micrographic Surgeon | E1554 | AR |
N | 207ND0900X | Dermatopathologist | E-1554 | AR |
N | 207NP0225X | Pediatric Dermatologist | E1554 | AR |
N | 207NS0135X | Procedural Dermatology | E-1554 | AR |
NPI | 1447256102 |
---|---|
Provider Name | Dr. Sandra Marchese Johnson |
First Address | Fort Smith, AR 72916-6103 |
Second Address | Fort Smith, AR 72916-6103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 04/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
139972001 | (05) | AR |