Provider Demographics
NPI:1750439337
Name:JOHNSON, LORI K (NP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:K
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:L
Other - Last Name:KRULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:550 HIGHWAY 105
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-9122
Mailing Address - Country:US
Mailing Address - Phone:719-488-9860
Mailing Address - Fax:719-488-9868
Practice Address - Street 1:550 HIGHWAY 105
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9122
Practice Address - Country:US
Practice Address - Phone:719-488-9860
Practice Address - Fax:719-488-9868
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO94098363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner