Provider Demographics
NPI:1477182053
Name:JOHNSON, HANNAH GRACE (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:GRACE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 W 6TH ST UNIT 4
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-6277
Mailing Address - Country:US
Mailing Address - Phone:847-910-0400
Mailing Address - Fax:
Practice Address - Street 1:564 RIO LINDO AVE STE 201
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1852
Practice Address - Country:US
Practice Address - Phone:530-715-8004
Practice Address - Fax:530-200-8362
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-05
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CA627202083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant