MEDICARE: LYNDEE JOHNSON FNP-C

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	AP4541	AZ
2	363L00000X	Nurse Practitioner	AP4541	AZ

General Provider Information

NPI Number	:	1285989608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNDEE JOHNSON FNP-C

Provider Business Mailing Address
First Line	:	890 W ELLIOT RD
Second Line	:	SUITE 103
City	:	GILBERT
State	:	AZ
Zip	:	85233-5102
Country	:	US
Telephone Number	:	480-545-1413
Fax Number	:	480-545-1434

Provider Business Practice Location Address
First Line	:	3300 W CAMELBACK RD BLDG 47
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85017-1097
Country	:	US
Telephone Number	:	602-639-6215
Fax Number	:	888-972-4657

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

Provider Enumeration Date	:	07/23/2012
Last Update Date	:	11/01/2024

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