Provider Demographics
NPI:1245406347
Name:JOHNSON, MANDY J (WHNP)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 EAST 5900 SOUTH
Mailing Address - Street 2:B-104
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7257
Mailing Address - Country:US
Mailing Address - Phone:801-265-1266
Mailing Address - Fax:801-265-0755
Practice Address - Street 1:166 E 5900 S
Practice Address - Street 2:B-104
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7257
Practice Address - Country:US
Practice Address - Phone:801-265-1266
Practice Address - Fax:801-265-0755
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT362724-4405363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health