Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 4333 | WI |
NPI | 1003882044 |
---|---|
Provider Name | Linda Kay Johnson |
First Address | Madison, WI 53715 |
Second Address | Madison, WI 53715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 21/08/2017 |