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General NPI Number Information
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NPI Number | 1467420422
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Entity Type | Individual
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Provider Name | DAVID ROBERT JOHNSEN NAVY IDC
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Gender | Male
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 06/06/2008
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Provider Practice Location Address
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Address Line | 3001A SIXTH STREET NAVAL HOSPITAL FISHER CLINIC
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City | GREAT LAKES
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State | IL
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Zip | 60088
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Country | US
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Telephone | 847-688-2469
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Fax | 847-688-2512
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Provider Business Mailing Address
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Address Line | 1130 BOB OFARRELL LN
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City | BEACH PARK
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State | IL
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Zip | 60099-4512
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Country | US
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Telephone | 847-263-8867
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1710I1002X
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Taxonomy Name | Independent Duty Corpsman
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License Number |
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License Number State |
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