Provider Demographics
NPI:1144405622
Name:JOHNSON, LAURA DARLENE (FNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:DARLENE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9551 PASEO DEL NORTE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2975
Mailing Address - Country:US
Mailing Address - Phone:505-800-7050
Mailing Address - Fax:
Practice Address - Street 1:481 SANDIA LOOP
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-7076
Practice Address - Country:US
Practice Address - Phone:505-771-5116
Practice Address - Fax:505-771-5127
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-07103363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM81834748Medicaid
8HM967OtherMEDICARE
MSR859509Medicaid