Provider Demographics
NPI:1306389432
Name:JOHNSON, HOLLIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:HOLLIE
Middle Name:
Last Name:JOHNSON
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 1:705 MARKETPLACE PLZ STE 200
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-1841
Mailing Address - Country:US
Mailing Address - Phone:970-879-6663
Mailing Address - Fax:970-871-1234
Practice Address - Street 1:8185 STATE HIGHWAY 789
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-2942
Practice Address - Country:US
Practice Address - Phone:307-206-9300
Practice Address - Fax:970-871-1234
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY23659.1553363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily