Provider Demographics
NPI:1235575788
Name:JOHNSON, ADRIENNE JANE (FNP, BSN, MSN)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:JANE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP, BSN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2669 ASPEN HEIGHTS LOOP
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-6713
Mailing Address - Country:US
Mailing Address - Phone:907-952-2296
Mailing Address - Fax:
Practice Address - Street 1:360 BONIFACE PKWY UNIT A11
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4908
Practice Address - Country:US
Practice Address - Phone:907-332-2400
Practice Address - Fax:907-332-2405
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1359363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1584108Medicaid