Healthcare Provider Details

I. General information

NPI: 1831537497
Provider Name (Legal Business Name): MARCHELE LYNETTE JOHNSON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S UNIVERSITY BLVD BLDG 1 SUITE 1B
MOBILE AL
36609-7859
US

IV. Provider business mailing address

820 S UNIVERSITY BLVD BLDG 1 SUITE 1B
MOBILE AL
36609-7859
US

V. Phone/Fax

Practice location:
  • Phone: 251-633-5155
  • Fax: 251-633-5125
Mailing address:
  • Phone: 251-633-5155
  • Fax: 251-633-5125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-123856
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: