MEDICARE: DR. MICHELLE ANN JOHNSON ND

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	175F00000X	Naturopath

General Provider Information

NPI Number	:	1972713089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE ANN JOHNSON ND

Provider Business Mailing Address
First Line	:	708 ALTAMIRA RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-6011
Country	:	US
Telephone Number	:	702-363-0446
Fax Number	:	702-363-0446

Provider Business Practice Location Address
First Line	:	708 ALTAMIRA RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-6011
Country	:	US
Telephone Number	:	702-363-0446
Fax Number	:	702-363-0446

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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