Provider Demographics
NPI:1396847331
Name:JOHNSON, ANNETTE J (ARNP)
Entity Type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WEST MAIN STREET
Mailing Address - Street 2:BOX 278
Mailing Address - City:LIME SPRINGS
Mailing Address - State:IA
Mailing Address - Zip Code:52155-0278
Mailing Address - Country:US
Mailing Address - Phone:563-566-2243
Mailing Address - Fax:
Practice Address - Street 1:101 WEST MAIN STREET
Practice Address - Street 2:BOX 278
Practice Address - City:LIME SPRINGS
Practice Address - State:IA
Practice Address - Zip Code:52155-0278
Practice Address - Country:US
Practice Address - Phone:563-566-2243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA086077363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAR02976Medicare UPIN
IA16223Medicare ID - Type UnspecifiedARNP