Provider Demographics
NPI:1508844861
Name:JOHNSON, ELTON EDWARD JR (APRN)
Entity Type:Individual
Prefix:MR
First Name:ELTON
Middle Name:EDWARD
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:98-139 KANUKU ST
Mailing Address - Street 2:APT 109
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5123
Mailing Address - Country:US
Mailing Address - Phone:808-488-1237
Mailing Address - Fax:
Practice Address - Street 1:400 SAND ISLAND PKWY
Practice Address - Street 2:USCG
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4326
Practice Address - Country:US
Practice Address - Phone:808-842-2930
Practice Address - Fax:808-832-3281
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX583059163WG0000X
HI45098163WP2201X
TX69774164X00000X
HI675363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Not Answered163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Not Answered164X00000XNursing Service ProvidersLicensed Vocational Nurse
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily