Provider Demographics
NPI:1982220232
Name:JOHNSON, NICOLE ANN (RP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ANN
Other - Last Name:ESTABROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RP
Mailing Address - Street 1:624 PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:NE
Mailing Address - Zip Code:69022-6597
Mailing Address - Country:US
Mailing Address - Phone:308-697-3400
Mailing Address - Fax:
Practice Address - Street 1:624 PATTERSON ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:NE
Practice Address - Zip Code:69022-6597
Practice Address - Country:US
Practice Address - Phone:308-697-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11307183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist