Provider Demographics
NPI:1477239499
Name:JOHANSON, BRITNI
Entity Type:Individual
Prefix:
First Name:BRITNI
Middle Name:
Last Name:JOHANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3803 OSBORNE DR W
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-9139
Mailing Address - Country:US
Mailing Address - Phone:402-463-0052
Mailing Address - Fax:
Practice Address - Street 1:3803 OSBORNE DR W
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-9139
Practice Address - Country:US
Practice Address - Phone:402-463-0052
Practice Address - Fax:402-463-0219
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician