Provider Demographics
NPI:1629133483
Name:JOHNSON, SANDRA LEE (ANP)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 210095
Mailing Address - Street 2:1225 EAST LOWELL ST.
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85721-0095
Mailing Address - Country:US
Mailing Address - Phone:520-626-9305
Mailing Address - Fax:520-626-5736
Practice Address - Street 1:1225 EAST LOWELL STREET
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721-0095
Practice Address - Country:US
Practice Address - Phone:520-626-9305
Practice Address - Fax:520-626-5736
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP 1098363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health