Provider Demographics
NPI:1558615419
Name:JOHNSON, ALICE NAOMI (NP-C)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:NAOMI
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 W. OUTER DRIVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235
Mailing Address - Country:US
Mailing Address - Phone:313-966-2800
Mailing Address - Fax:313-966-7797
Practice Address - Street 1:6001 W. OUTER DRIVE
Practice Address - Street 2:SUITE 207
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235
Practice Address - Country:US
Practice Address - Phone:313-966-2800
Practice Address - Fax:313-966-7797
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704218703363LC0200X, 363LC1500X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care