Provider Demographics
NPI:1821549619
Name:JOHNSON, BRIANA DAWN (PA)
Entity Type:Individual
Prefix:MRS
First Name:BRIANA
Middle Name:DAWN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5965 W WOLF CREEK CT
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84118-9201
Mailing Address - Country:US
Mailing Address - Phone:801-787-8578
Mailing Address - Fax:
Practice Address - Street 1:5965 W WOLF CREEK CT
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84118-9201
Practice Address - Country:US
Practice Address - Phone:801-787-8578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6523363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical