Provider Demographics
NPI:1619904760
Name:JOHNSON, JUDITH ANN (NP)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:205 S FRANCISCA AVE
Mailing Address - Street 2:#4
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3354
Mailing Address - Country:US
Mailing Address - Phone:310-292-1303
Mailing Address - Fax:310-372-7874
Practice Address - Street 1:205 S FRANCISCA AVE
Practice Address - Street 2:#4
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3354
Practice Address - Country:US
Practice Address - Phone:310-292-1303
Practice Address - Fax:310-372-7874
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANP9652 RN511482363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily