Provider Demographics
NPI:1982807830
Name:JOHNSON, CONSTANCE JOANN (PNP)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:JOANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6149
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-6149
Mailing Address - Country:US
Mailing Address - Phone:808-887-6543
Mailing Address - Fax:808-887-6294
Practice Address - Street 1:75-170 HUALALAI RD
Practice Address - Street 2:D-214
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1779
Practice Address - Country:US
Practice Address - Phone:808-325-5805
Practice Address - Fax:808-657-4796
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MP0037363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics