Provider Demographics
NPI:1619289915
Name:JOHNSON, DANA MICHELLE (NP)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:MICHELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 AIRPORT BLVD
Mailing Address - Street 2:SUITE D-430
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6705
Mailing Address - Country:US
Mailing Address - Phone:251-639-2101
Mailing Address - Fax:251-639-9122
Practice Address - Street 1:6701 AIRPORT BLVD
Practice Address - Street 2:SUITE D-430
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6705
Practice Address - Country:US
Practice Address - Phone:251-639-2101
Practice Address - Fax:251-639-9122
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-035293363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-08436OtherBLUE CROSS BLUE SHIELD
AL126740Medicaid
AL511-08436OtherBLUE CROSS BLUE SHIELD