Most Relevant Information
Provider Data
| NPI Number: | 1003537564 |
| Provider Name: | MATTIE RAYDON JOHNSON |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 44901 |
Most Important Dates
| Enumeration Date: | 09/02/2022 |
| Last Updated: | 09/02/2022 |
Provider Practice Location
625 ALBANY AVE
TORRINGTON
WY
822401530
Practice Location Phone/Fax
| Phone: | 3075322107 |
| Fax: |
Provider Mailing Location
625 ALBANY AVE
TORRINGTON
WY
822401530
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |