Provider Demographics
NPI:1699365528
Name:JOHNSON, KATHERINE M
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NE
Mailing Address - Zip Code:68069-2249
Mailing Address - Country:US
Mailing Address - Phone:402-669-3197
Mailing Address - Fax:
Practice Address - Street 1:800 N FRONT ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NE
Practice Address - Zip Code:68069-2249
Practice Address - Country:US
Practice Address - Phone:402-669-3197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist