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General NPI Number Information
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NPI Number | 1851800536
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Entity Type | Individual
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Provider Name | PAMELA TRAPP JOHNSON CERTIFIED HAIR LOSS
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Gender | Female
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Dates
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Enumeration Date | 09/25/2017
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Last Update Date | 09/25/2017
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Provider Practice Location Address
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Address Line | 196 KNIGHT ESTATES CIR
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City | FUQUAY VARINA
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State | NC
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Zip | 27526
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Country | US
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Telephone | 919-586-1752
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Fax |
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Provider Business Mailing Address
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Address Line | P O BOX 160
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City | KIPLING
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State | NC
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Zip | 27543
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Country | US
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Telephone | 919-586-1752
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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 | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number |
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License Number State |
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