Healthcare Provider Details

I. General information

NPI: 1457551392
Provider Name (Legal Business Name): AIMEE D JOHNSON-WIRT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 RESEARCH PARKWAY
COLORADO SPRINGS CO
80920
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 719-522-1134
  • Fax: 719-268-2819
Mailing address:
  • Phone: 719-463-5600
  • Fax: 719-538-2990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0055826
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: