Provider Demographics
NPI:1700156783
Name:JOHNSON, NEVA L (NP)
Entity type:Individual
Prefix:
First Name:NEVA
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 M L KING AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48502-2002
Mailing Address - Country:US
Mailing Address - Phone:810-238-7226
Mailing Address - Fax:810-239-5518
Practice Address - Street 1:529 M L KING AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48502-2002
Practice Address - Country:US
Practice Address - Phone:810-238-7226
Practice Address - Fax:810-239-5518
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704224292363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704224292OtherSTATE OF MICHIGAN