Provider Demographics
NPI:1376858746
Name:JOHNSON, CHRISTINA SUSANNE (FNP-C)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:SUSANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-0010
Mailing Address - Country:US
Mailing Address - Phone:706-302-1627
Mailing Address - Fax:772-413-4275
Practice Address - Street 1:240 N EAST PROMONTORY
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2950
Practice Address - Country:US
Practice Address - Phone:801-854-7347
Practice Address - Fax:772-413-4275
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0103396-C-NP363LF0000X
WAAP61635778363LF0000X
AZ317529363LF0000X
UT13794235-4405363LF0000X
GARN176056363LF0000X
VT101.0137534363LF0000X
FLTPAN2704363LF0000X
OHAPRN.CNP.0038228363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily