Provider Demographics
NPI:1275083115
Name:JOHNSON, ANGELA M (CRNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:MONDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-1566
Mailing Address - Fax:717-851-6969
Practice Address - Street 1:2250 E MARKET ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-2857
Practice Address - Country:US
Practice Address - Phone:717-851-1566
Practice Address - Fax:717-812-3950
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016603363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner