Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 44716 | WI |
N | 207RC0000X | Internist - Cardiovascular Disease | 44716 | WI |
NPI | 1548236581 |
---|---|
Provider Name | Maryl R Johnson |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 15/01/2021 |