Provider Demographics
NPI:1669510525
Name:JOHNSON, DALE J (RN NP)
Entity Type:Individual
Prefix:MS
First Name:DALE
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN NP
Other - Prefix:
Other - First Name:DALE
Other - Middle Name:J
Other - Last Name:GOULD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:POB 906
Mailing Address - Street 2:230 ALDER DRIVE
Mailing Address - City:BOLINAS
Mailing Address - State:CA
Mailing Address - Zip Code:94924
Mailing Address - Country:US
Mailing Address - Phone:415-868-1578
Mailing Address - Fax:415-868-2152
Practice Address - Street 1:7 WHARF ROAD
Practice Address - Street 2:BOLINAS FAMILY PRACTICE
Practice Address - City:BOLINAS
Practice Address - State:CA
Practice Address - Zip Code:94924
Practice Address - Country:US
Practice Address - Phone:415-868-1578
Practice Address - Fax:415-868-2152
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAV303572363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health