Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | V303572 | CA |
NPI | 1669510525 |
---|---|
Provider Name | Ms. Dale J Johnson |
First Address | Bolinas, CA 94924 |
Second Address | Bolinas, CA 94924 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2007 |
Last Update Date | 08/07/2007 |