Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | AP135787 | TX |
NPI | 1093218299 |
---|---|
Provider Name | Mica K Johnese |
First Address | Saginaw, TX 76179-0983 |
Second Address | Dallas, TX 75212-2471 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2018 |
Last Update Date | 14/03/2018 |