Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 95007354 | CA |
NPI | 1033638168 |
---|---|
Provider Name | Lauralie Johnson |
First Address | South Pasadena, CA 91030-3311 |
Second Address | Glendale, CA 91204-4613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2017 |
Last Update Date | 09/09/2017 |