Provider Demographics
NPI:1811448426
Name:JOHNSON, DANIEL BLAIR (NP-C)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:BLAIR
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 7TH ST STE B-3
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4703
Mailing Address - Country:US
Mailing Address - Phone:814-204-3080
Mailing Address - Fax:814-204-3086
Practice Address - Street 1:1304 7TH ST STE B-3
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4703
Practice Address - Country:US
Practice Address - Phone:814-204-3080
Practice Address - Fax:814-204-3086
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016671363LA2200X, 363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology