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General NPI Number Information
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NPI Number | 1497071641
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Entity Type | Individual
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Provider Name | KATHLEEN JOHNSON RN
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Gender | Female
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Dates
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Enumeration Date | 04/13/2010
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Last Update Date | 04/13/2010
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Provider Practice Location Address
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Address Line | 208 MAPLE ST., APT. 208
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City | BIG RAPIDS
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State | MI
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Zip | 49307
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Country | US
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Telephone | 231-796-8594
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Fax |
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Provider Business Mailing Address
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Address Line | 208 MAPLE ST APT 209
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City | BIG RAPIDS
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State | MI
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Zip | 49307-1885
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Country | US
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Telephone | 231-796-8594
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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 | 372600000X
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Taxonomy Name | Adult Companion
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License Number | 4704134887
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License Number State | MI
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