Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | RN131922 | LA |
NPI | 1073049995 |
---|---|
Provider Name | Mrs. Holly Johnson |
First Address | Shreveport, LA 71105-5415 |
Second Address | Shreveport, LA 71115-2302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2017 |
Last Update Date | 11/05/2017 |