Provider Demographics
NPI:1922376524
Name:JOHNSON, ANN E (LAC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 DELAWARE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6490
Mailing Address - Country:US
Mailing Address - Phone:303-588-5127
Mailing Address - Fax:
Practice Address - Street 1:701 DELAWARE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6490
Practice Address - Country:US
Practice Address - Phone:303-588-5127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1387171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist