Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 149591 | MO |
N | 363LW0102X | Nurse Practitioner - Women's Health | 44564 | KS |
NPI | 1093849135 |
---|---|
Provider Name | Viola June Johnson |
First Address | Overland Park, KS 66211-1303 |
Second Address | Kansas City, MO 64110-1687 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
06215014 | BCBS KC GRP # (01) | MO |
09841038 | BCBS KC PROVIDER# (01) | MO |
110035 | BCBS KS GRP # (01) | KS |
161053 | BCBS KS PROVIDER # (01) | KS |