Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | C93093 | NC |
NPI | 1366056913 |
---|---|
Provider Name | Ms. Aleta Michelle Johnson |
First Address | Charlotte, NC 28269 |
Second Address | Charlotte, NC 28262 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2020 |
Last Update Date | 01/09/2020 |