Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | DR.0064520 | CO |
NPI | 1285089052 |
---|---|
Provider Name | Juliana Wilking-Johnson |
First Address | Sugar Land, TX 77478-3550 |
Second Address | Westminster, CO 80031-3807 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2016 |
Last Update Date | 11/08/2020 |