Provider Demographics
NPI:1700998440
Name:JOHNSON, PAULA ANN (NP)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:PAULA
Other - Middle Name:ANN
Other - Last Name:BOTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:65 AIRPORT PKWY
Mailing Address - Street 2:STE 114
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1439
Mailing Address - Country:US
Mailing Address - Phone:317-807-0268
Mailing Address - Fax:
Practice Address - Street 1:8177 CLEARVISTA PKWY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1662
Practice Address - Country:US
Practice Address - Phone:317-621-7801
Practice Address - Fax:317-621-7205
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001130363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01009924OtherRR MEDICARE PTAN
INP01009924OtherRR MEDICARE PTAN
INQ42169Medicare UPIN