Provider Demographics
NPI:1356334221
Name:JOHNSON, CHRISTOPHER M (RN, FNP, PA)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:RN, FNP, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 DEL NORTE AVE
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4121
Mailing Address - Country:US
Mailing Address - Phone:530-755-0856
Mailing Address - Fax:530-755-0858
Practice Address - Street 1:3055 MUIR RD
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-9103
Practice Address - Country:US
Practice Address - Phone:530-218-5861
Practice Address - Fax:844-268-7287
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13576363A00000X
CA4964363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP0049640Medicaid
CAR21711Medicare UPIN
CAZZZ42580ZMedicare ID - Type Unspecified