MEDICARE: ANGELICA M. JOHNSON F.N.P.

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	363LF0000X	Family Nurse Practitioner	RN23658	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184615197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELICA M. JOHNSON F.N.P.

Provider Business Mailing Address
First Line	:	PO BOX 249
Second Line	:
City	:	FORT BENTON
State	:	MT
Zip	:	59442-0249
Country	:	US
Telephone Number	:	406-622-5485
Fax Number	:	406-622-3882

Provider Business Practice Location Address
First Line	:	1203 15 ST.
Second Line	:
City	:	FORT BENTON
State	:	MT
Zip	:	59442
Country	:	US
Telephone Number	:	406-622-5485
Fax Number	:	406-622-3882

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	07/08/2007

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