Most Relevant Information
Provider Data
| NPI Number: | 1003493826 |
| Provider Name: | MARY LYNN JOHNSON |
| Entity Type: | Individual |
| Taxonomy Code: | 163WH0200X |
| Specialty: | Registered Nurse |
| License Number: | 0094898 |
Most Important Dates
| Enumeration Date: | 03/26/2021 |
| Last Updated: | 03/26/2021 |
Provider Practice Location
1567 48TH ST
BOULDER
CO
803031127
Practice Location Phone/Fax
| Phone: | 3035069439 |
| Fax: |
Provider Mailing Location
1567 48TH ST
BOULDER
CO
803031127
Provider Mailing Phone/Fax
| Phone: | 3035069439 |
| Fax: |