Provider Demographics
NPI:1477106383
Name:JOHNSON, ANITA LEIGH (NP)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:LEIGH
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 1:3349 G ST STE C
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-0978
Mailing Address - Country:US
Mailing Address - Phone:209-580-4638
Mailing Address - Fax:209-580-4163
Practice Address - Street 1:3349 G STREET
Practice Address - Street 2:SUITE C BLDG. K , EL PORTAL PLAZA
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340
Practice Address - Country:US
Practice Address - Phone:209-580-4638
Practice Address - Fax:809-580-4163
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF12180594363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily