Provider Demographics
NPI:1326107764
Name:JOHNSON, REBECCA N (NP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:N
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 RUNNING CREEK WAY
Mailing Address - Street 2:BLDG B
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-5563
Mailing Address - Country:US
Mailing Address - Phone:801-766-4214
Mailing Address - Fax:801-407-3052
Practice Address - Street 1:3300 RUNNING CREEK WAY
Practice Address - Street 2:BLDG B
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5563
Practice Address - Country:US
Practice Address - Phone:801-766-4214
Practice Address - Fax:801-407-3052
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT273358363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily