Most Relevant Information
Provider Data
| NPI Number: | 1003470956 |
| Provider Name: | JENNIFER JOHNSON |
| Entity Type: | Individual |
| Taxonomy Code: | 3747P1801X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/25/2019 |
| Last Updated: | 04/25/2019 |
Provider Practice Location
1490 E BELTLINE AVE SE
GRAND RAPIDS
MI
495064336
Practice Location Phone/Fax
| Phone: | 0000000000 |
| Fax: |
Provider Mailing Location
1490 E BELTLINE AVE SE
GRAND RAPIDS
MI
495064336
Provider Mailing Phone/Fax
| Phone: | 2694927842 |
| Fax: |