Provider Demographics
NPI:1396842100
Name:JOHNSON, PATRICIA J (APRN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 W HIGHWAY 370
Mailing Address - Street 2:P.O. BOX 527
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-4522
Mailing Address - Country:US
Mailing Address - Phone:402-332-4559
Mailing Address - Fax:402-332-4598
Practice Address - Street 1:102 W HIGHWAY 370
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-4522
Practice Address - Country:US
Practice Address - Phone:402-332-4559
Practice Address - Fax:402-332-4598
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110601363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEQ09765Medicare UPIN