Provider Demographics
NPI:1205167046
Name:GAY JOHNSON, MAUREEN LORRAINE (CRNP)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:LORRAINE
Last Name:GAY JOHNSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:L
Other - Last Name:GAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:517 N RAMUNNO DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-3047
Mailing Address - Country:US
Mailing Address - Phone:215-364-8412
Mailing Address - Fax:215-364-8730
Practice Address - Street 1:1982 W MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-6917
Practice Address - Country:US
Practice Address - Phone:480-677-8282
Practice Address - Fax:480-535-0962
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010677363LA2200X
AZAP8969363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health