Provider Demographics
NPI:1124011275
Name:JOHNSON, DONNA MARIE (RNC, FNP-C)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RNC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6851 E COTTONWOOD
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:TX
Mailing Address - Zip Code:79758
Mailing Address - Country:US
Mailing Address - Phone:325-721-3187
Mailing Address - Fax:
Practice Address - Street 1:540 W 5TH ST
Practice Address - Street 2:SUITE 470
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5034
Practice Address - Country:US
Practice Address - Phone:432-580-8330
Practice Address - Fax:432-580-8333
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX583042363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP81882Medicare UPIN