Provider Demographics
NPI:1205412590
Name:JOHANSSON, AMY LAWAN (FNP-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LAWAN
Last Name:JOHANSSON
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 1:272 CAMINO DEL REY
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240-1726
Mailing Address - Country:US
Mailing Address - Phone:307-231-0749
Mailing Address - Fax:
Practice Address - Street 1:272 CAMINO DEL REY
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-1726
Practice Address - Country:US
Practice Address - Phone:307-231-0749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY47188363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care