Provider Demographics
NPI:1033107891
Name:JOHNSON, JANE MARGUERITE (FNP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:MARGUERITE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:MARGUERITE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4974 N FRESNO ST
Mailing Address - Street 2:SUITE 526
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-0317
Mailing Address - Country:US
Mailing Address - Phone:559-325-2764
Mailing Address - Fax:559-325-2764
Practice Address - Street 1:2755 HERNDON AVE
Practice Address - Street 2:CLOVIS COMMUNITY MEDICAL CENTER
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611
Practice Address - Country:US
Practice Address - Phone:559-638-2252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZZZ24398Z363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06128ZMedicare PIN
CAZZZ24398ZMedicare ID - Type UnspecifiedMEDICARE ID