Healthcare Provider Details

I. General information

NPI: 1033107891
Provider Name (Legal Business Name): JANE MARGUERITE JOHNSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANE MARGUERITE JOHNSON

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 HERNDON AVE CLOVIS COMMUNITY MEDICAL CENTER
CLOVIS CA
93611
US

IV. Provider business mailing address

4974 N FRESNO ST SUITE 526
FRESNO CA
93726-0317
US

V. Phone/Fax

Practice location:
  • Phone: 559-638-2252
  • Fax:
Mailing address:
  • Phone: 559-325-2764
  • Fax: 559-325-2764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberZZZ24398Z
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: