Provider Demographics
NPI:1295049229
Name:JOHNSON, CHRISTINE M (MSN, ANP-BC, PMHNP)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:M
Last Name:JOHNSON
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Gender:F
Credentials:MSN, ANP-BC, PMHNP
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Mailing Address - Street 1:286 EUCLID AVE
Mailing Address - Street 2:PROJECT ENABLE WELLNESS & RECOVERY CTR
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114
Mailing Address - Country:US
Mailing Address - Phone:619-266-2111
Mailing Address - Fax:619-266-0496
Practice Address - Street 1:286 EUCLID AVE
Practice Address - Street 2:PROJECT ENABLE WELLNESS & RECOVERY CTR
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114
Practice Address - Country:US
Practice Address - Phone:619-266-2111
Practice Address - Fax:619-266-0496
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2012-11-08
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Provider Licenses
StateLicense IDTaxonomies
261QP2300X
CA526349163W00000X
CA20022363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse