MEDICARE: MRS. WANDA JOHNSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1744R1103X	Research Study Abstracter/Coder

General Provider Information

NPI Number	:	1538212360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WANDA JOHNSON

Provider Business Mailing Address
First Line	:	1400 N NORMA ST
Second Line	:	SUITE 133
City	:	RIDGECREST
State	:	CA
Zip	:	93555-2575
Country	:	US
Telephone Number	:	760-499-7406
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 N NORMA ST
Second Line	:	SUITE 133
City	:	RIDGECREST
State	:	CA
Zip	:	93555-2575
Country	:	US
Telephone Number	:	760-499-7406
Fax Number	:	760-499-7479

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/12/2007

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