Provider Demographics
NPI:1033195920
Name:JOHNSON, ANNETTE LYNN (NP)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2980
Mailing Address - Country:US
Mailing Address - Phone:970-242-0920
Mailing Address - Fax:970-256-6539
Practice Address - Street 1:1060 ORCHARD AVE
Practice Address - Street 2:SUITE N
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2997
Practice Address - Country:US
Practice Address - Phone:970-256-6345
Practice Address - Fax:970-242-3690
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0000965-NP363L00000X
COCO 104061363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner