Provider Demographics
NPI:1417262528
Name:JOHNSON, NANCY MOE (PA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:MOE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA
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Other - Last Name:
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Mailing Address - Street 1:1905 E HUEBBE PKWY
Mailing Address - Street 2:BELOIT HEALTH SYSTEM INC
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1842
Mailing Address - Country:US
Mailing Address - Phone:608-364-2293
Mailing Address - Fax:608-364-5452
Practice Address - Street 1:1905 E HUEBBE PKWY
Practice Address - Street 2:BELOIT CLINIC
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-1842
Practice Address - Country:US
Practice Address - Phone:608-364-1460
Practice Address - Fax:608-363-7317
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2016-11-16
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Provider Licenses
StateLicense IDTaxonomies
CO3203363AM0700X
WI2640-33363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical