Provider Demographics
NPI:1598002677
Name:JOHNSON, ADAM DUANE (APRN)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:DUANE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 MEDICAL DR STE 301
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-8927
Mailing Address - Country:US
Mailing Address - Phone:801-292-1464
Mailing Address - Fax:
Practice Address - Street 1:520 MEDICAL DR STE 301
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-8927
Practice Address - Country:US
Practice Address - Phone:801-292-1464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6595846-4408363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics