Healthcare Provider Details

I. General information

NPI: 1386307015
Provider Name (Legal Business Name): ELISABETH DAWN JOHNSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 10/04/2026
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 BARNES AVE
LA JUNTA CO
81050-2138
US

IV. Provider business mailing address

711 BARNES AVE
LA JUNTA CO
81050-2138
US

V. Phone/Fax

Practice location:
  • Phone: 719-384-5446
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.0171964
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: