Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251C2600X | Cardiopulmonary | 05010616A | IN |
NPI | 1235677915 |
---|---|
Provider Name | Rebecca Johnson |
First Address | Indianapolis, IN 46202-5306 |
Second Address | Indianapolis, IN 46202-5306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2017 |
Last Update Date | 02/02/2017 |