Antqualene Lavette Johnson PA-C

NPI 1720346943 - Physician Assistant - 363AM0700X

NPI Details
NPI 1720346943
Gender Female
Enumeration Date 04/25/2012
Last Updated 04/25/2012
Entity Type Individual
Active Over 5 years ago
Practice Location
2260 GLORY LOOP
BLDG 1260
FORT POLK LA, 71446, US
Phone (337) 531-4127
Fax
Business Location
2260 GLORY LOOP
BLDG 1260
FORT POLK LA, 71446, US
Phone (337) 531-4127
Fax
Toxanomy
Taxonomy Code 363AM0700X
License State
License Number 1103343
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According to our database, Mrs. Antqualene Lavette Johnson PA-C NPI is 1720346943, taxonomy code is 363AM0700X and license number is 1103343, license state is located at . Antqualene Lavette Johnson PA-C physically located at 2260 Glory Loop, Fort Polk LA, 71446. NPI Number Antqualene Lavette Johnson PA-C has the Individual type.

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1720346943 NPI number is provided on an as is basis without warranty of any kind. 1720346943 is maintained by the National Plan & Provider Enumeration System. The contents of Antqualene Lavette Johnson PA-C are for informational purposes only.