Provider Demographics
NPI:1508902412
Name:JOHNSON, CAMILLE ROSE (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:CAMILLE
Middle Name:ROSE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 JEFFERSON ST NE
Mailing Address - Street 2:SUITE G
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4355
Mailing Address - Country:US
Mailing Address - Phone:505-225-4044
Mailing Address - Fax:505-508-5284
Practice Address - Street 1:7301 JEFFERSON ST NE
Practice Address - Street 2:SUITE G
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4355
Practice Address - Country:US
Practice Address - Phone:505-225-4044
Practice Address - Fax:505-508-5284
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR36488363LF0000X
NMCNP00782363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM7001754Medicaid
NM7001754Medicaid