Provider Demographics
NPI:1700196821
Name:JOHNSON, AMBER LOUISE (CRNP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LOUISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 REISTERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1335
Mailing Address - Country:US
Mailing Address - Phone:410-484-4044
Mailing Address - Fax:410-740-4776
Practice Address - Street 1:1860 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-1335
Practice Address - Country:US
Practice Address - Phone:410-484-4044
Practice Address - Fax:410-740-4776
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR169566363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1722013Medicaid
MD201818ZDN3Medicare PIN