Provider Demographics
NPI:1346200243
Name:JOHNSON, TERRI LYNNE (PA C)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:LYNNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:LYNNE
Other - Last Name:NEFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA C
Mailing Address - Street 1:2201 BRUNSWICK DR STE 1200
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-8350
Mailing Address - Country:US
Mailing Address - Phone:717-637-0470
Mailing Address - Fax:717-637-4987
Practice Address - Street 1:2201 BRUNSWICK DR STE 1200
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-8350
Practice Address - Country:US
Practice Address - Phone:717-637-0470
Practice Address - Fax:717-637-4987
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000739L363AM0700X
PAOA003570363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S35958Medicare UPIN
PA417246ZEA5Medicare PIN