Provider Demographics
NPI:1164679254
Name:JOHNSON, MARSHA RENEE (FNP BC)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:RENEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 E A ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2239
Mailing Address - Country:US
Mailing Address - Phone:307-234-8700
Mailing Address - Fax:307-234-8750
Practice Address - Street 1:1450 E A ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2239
Practice Address - Country:US
Practice Address - Phone:307-234-8700
Practice Address - Fax:307-234-8750
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY16690.0271363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily