Healthcare Provider Details

I. General information

NPI: 1396974432
Provider Name (Legal Business Name): ERIC ROSS JOHNSON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2009
Last Update Date: 07/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1733 VINE ST
DENVER CO
80206-1119
US

IV. Provider business mailing address

4141 E DICKENSON PL
DENVER CO
80222-6012
US

V. Phone/Fax

Practice location:
  • Phone: 303-504-1000
  • Fax: 303-377-1105
Mailing address:
  • Phone: 303-504-6778
  • Fax: 303-782-0916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number189366
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: