Provider Information for 1255600623
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KURT LAURENZ JOHNSON LISW
Sex: Male
NPI: 1255600623
Last Updated: 2012-02-28
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1255600623 | ||||||||
| Enumeration Date | 2011-12-14 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 184 UNSER BLVD NE RIO RANCHO, NM 87124-4045 United States Phone: 505-818-8760 | Fax: | ||||||||
| Primary Practice Address | 184 UNSER BLVD NE RIO RANCHO, NM 87124-4045 United States Phone: 505-896-0928 | Fax: | ||||||||
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