Provider Demographics
NPI:1679362867
Name:JOHANSSON, ESTELLA CHANTEL (MSN RN)
Entity type:Individual
Prefix:
First Name:ESTELLA
Middle Name:CHANTEL
Last Name:JOHANSSON
Suffix:
Gender:
Credentials:MSN RN
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:SUE
Other - Last Name:BIRKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2125 E APACHE BLVD UNIT 1120
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-0161
Mailing Address - Country:US
Mailing Address - Phone:602-418-7788
Mailing Address - Fax:
Practice Address - Street 1:9097 E DESERT COVE AVE STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6276
Practice Address - Country:US
Practice Address - Phone:602-418-7788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV821621163W00000X
AZRN178872163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse