Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | RN135756 | GA |
NPI | 1013963024 |
---|---|
Provider Name | Mrs. Claudia Victoria Cano Johnson |
First Address | College Park, GA 30337-1404 |
Second Address | East Point, GA 30344-3603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 09/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000972727A | (05) | GA |