Provider Demographics
NPI:1093037228
Name:JOHNSON, HEATHER RENEE (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:RENEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:RENEE
Other - Last Name:PROCTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 E UNIVERSITY AVE
Mailing Address - Street 2:3 WEST
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316-2302
Mailing Address - Country:US
Mailing Address - Phone:515-263-5153
Mailing Address - Fax:515-263-5158
Practice Address - Street 1:700 E UNIVERSITY AVE
Practice Address - Street 2:3 WEST
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2302
Practice Address - Country:US
Practice Address - Phone:515-263-5153
Practice Address - Fax:515-263-5158
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA114291163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice