Provider Demographics
NPI:1881927408
Name:JOHNSON, CALLIE M (NP)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:M
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 1:2240 BUCHTEL BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3447
Mailing Address - Country:US
Mailing Address - Phone:303-871-2205
Mailing Address - Fax:
Practice Address - Street 1:2240 BUCHTEL BLVD STE 104
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3447
Practice Address - Country:US
Practice Address - Phone:303-871-2205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA284012363LA2200X
COC-APN.0000856-C-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health