MEDICARE: MRS. ERIN JOHNSON

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	28147844A	IN
2	363LF0000X	Family Nurse Practitioner	71006388A	IN

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
2	71006388A	OTHER	IN	APN LICENSE

General Provider Information

NPI Number	:	1386001451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ERIN JOHNSON

Provider Business Mailing Address
First Line	:	PO BOX 781076
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48278-1076
Country	:	US
Telephone Number	:	317-528-4800
Fax Number	:	317-865-1479

Provider Business Practice Location Address
First Line	:	965 EMERSON PKWY STE J
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46143-6274
Country	:	US
Telephone Number	:	317-887-1060
Fax Number	:	317-887-1460

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

Provider Enumeration Date	:	01/20/2016
Last Update Date	:	04/27/2023

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Directions to “ MRS. ERIN JOHNSON ” Practice Location

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