Provider Demographics
NPI:1578187514
Name:JOHNSON, EMILY ANN (DO)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 5TH ST
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:IA
Mailing Address - Zip Code:52747-7737
Mailing Address - Country:US
Mailing Address - Phone:563-421-4487
Mailing Address - Fax:563-421-6681
Practice Address - Street 1:619 5TH ST
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:IA
Practice Address - Zip Code:52747-7737
Practice Address - Country:US
Practice Address - Phone:563-421-4487
Practice Address - Fax:563-421-6681
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-11891207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine