Healthcare Provider Details

I. General information

NPI: 1104851914
Provider Name (Legal Business Name): DANA JOHNSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19636 N 27TH AVE
PHOENIX AZ
85027-4013
US

IV. Provider business mailing address

PO BOX 15070
SCOTTSDALE AZ
85267-5070
US

V. Phone/Fax

Practice location:
  • Phone: 623-780-1999
  • Fax:
Mailing address:
  • Phone: 602-839-6968
  • Fax: 602-839-4144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3293
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: