Healthcare Provider Details

I. General information

NPI: 1285989608
Provider Name (Legal Business Name): LYNDEE JOHNSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 W CAMELBACK RD BLDG 47
PHOENIX AZ
85017-1097
US

IV. Provider business mailing address

890 W ELLIOT RD SUITE 103
GILBERT AZ
85233-5102
US

V. Phone/Fax

Practice location:
  • Phone: 602-639-6215
  • Fax: 888-972-4657
Mailing address:
  • Phone: 480-545-1413
  • Fax: 480-545-1434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4541
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP4541
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: