Provider Demographics
NPI:1609926120
Name:PARK-JOHNSON, NATALIE ANN
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:ANN
Last Name:PARK-JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:ANN
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:273 E 2300 N
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-7258
Mailing Address - Country:US
Mailing Address - Phone:801-737-4438
Mailing Address - Fax:
Practice Address - Street 1:934 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4250
Practice Address - Country:US
Practice Address - Phone:801-546-1168
Practice Address - Fax:801-544-0770
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other