Provider Demographics
NPI:1164195822
Name:JOHANSON, EMILY MAIRE (FNP-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MAIRE
Last Name:JOHANSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 WHETHERBURN DR
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8868
Mailing Address - Country:US
Mailing Address - Phone:412-992-6771
Mailing Address - Fax:
Practice Address - Street 1:13838 S 46TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-7800
Practice Address - Country:US
Practice Address - Phone:480-783-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ260887363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily