Johnson, Gerald Bruce

Johnson, Gerald Bruce is an sole proprietor health care provider with primary practice located at 4092 W Marble Way , Wasilla AK 99654-8752. He recently has only one registered license in Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities, which is considered as his primary health care specialty. Johnson, Gerald Bruce can be contacted via phone (907) 227-3524.

Contact Information

Primary practice address
4092 W Marble Way Wasilla AK 99654-8752
Phone: (907) 227-3524
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 320900000X Alaska

Profile Details

NPI number 1609443217
LBN Legal business name Johnson, Gerald Bruce
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 10th, 2021
Last updated Jul 21st, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1609443217 NPPES
Alaska MEDICAID 1705395

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