Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 4704218703 | MI |
Y | 363LC1500X | Nurse Practitioner - Community Health | 4704218703 | MI |
N | 363LP2300X | Nurse Practitioner - Primary Care | 4704218703 | MI |
NPI | 1558615419 |
---|---|
Provider Name | Ms. Alice Naomi Johnson |
First Address | Detroit, MI 48235 |
Second Address | Detroit, MI 48235 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2012 |
Last Update Date | 14/07/2016 |