Provider Demographics
NPI:1609284447
Name:JOHNSON NARVESON, MARIA LYNN (LAC)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:LYNN
Last Name:JOHNSON NARVESON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:610 WEST AVE STE A-2
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-1386
Mailing Address - Country:US
Mailing Address - Phone:715-296-7467
Mailing Address - Fax:888-262-0191
Practice Address - Street 1:610 WEST AVE STE A-2
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-1386
Practice Address - Country:US
Practice Address - Phone:715-296-7467
Practice Address - Fax:888-262-0191
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI836-55171100000X
MN1696171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist