Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 0879 | SD |
NPI | 1851385041 |
---|---|
Provider Name | Dr. Virginia P Johnson |
First Address | Sioux Falls, SD 57105-1501 |
Second Address | Sioux Falls, SD 57105-1501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0932020 | (05) | IA |
51017553609 | (05) | NE |
5601710 | (05) | SD |
D28490 | (02) | SD |