Provider Demographics
NPI:1013102979
Name:GREENBERG, JOHANNA E (PA-C)
Entity type:Individual
Prefix:MS
First Name:JOHANNA
Middle Name:E
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:220 MILLPOND
Mailing Address - Street 2:#100
Mailing Address - City:STANSBURY PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84074-9745
Mailing Address - Country:US
Mailing Address - Phone:435-843-3000
Mailing Address - Fax:435-843-3015
Practice Address - Street 1:220 MILLPOND
Practice Address - Street 2:#100
Practice Address - City:STANSBURY PARK
Practice Address - State:UT
Practice Address - Zip Code:84074-9745
Practice Address - Country:US
Practice Address - Phone:435-843-3000
Practice Address - Fax:435-843-3015
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT6718628-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant