Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath |
NPI | 1487819892 |
---|---|
Provider Name | Lauren Leann Johnson |
First Address | Chicago, IL 60645-4665 |
Second Address | Chicago, IL 60645-4665 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2008 |
Last Update Date | 24/07/2008 |