Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | A113258 | CA |
N | 207NS0135X | Procedural Dermatology | A113258 | CA |
NPI | 1508177163 |
---|---|
Provider Name | Mary Ann Nau Johnson |
First Address | Rancho Cordova, CA 95670-7956 |
Second Address | El Dorado Hills, CA 95762-9348 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2010 |
Last Update Date | 14/07/2015 |