MEDICARE: MRS. RACHEL RENAE JOHNSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	29317	NE
2	208000000X	Pediatrics Physician	29317	NE

General Provider Information

NPI Number	:	1083856025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RACHEL RENAE JOHNSON M.D.

Provider Business Mailing Address
First Line	:	988102 NEBRASKA MEDICAL CTR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68198-8102
Country	:	US
Telephone Number	:	402-559-6195
Fax Number	:

Provider Business Practice Location Address
First Line	:	5050 AMES AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68104-2323
Country	:	US
Telephone Number	:	402-595-2280
Fax Number	:	402-595-2283

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2009
Last Update Date	:	08/06/2016

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