Healthcare Provider Details

I. General information

NPI: 1407552052
Provider Name (Legal Business Name): DEANN MARIE JOHNSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1697 COLE BLVD STE 125
LAKEWOOD CO
80401-3308
US

IV. Provider business mailing address

1697 COLE BLVD STE 125
LAKEWOOD CO
80401-3308
US

V. Phone/Fax

Practice location:
  • Phone: 303-716-8039
  • Fax:
Mailing address:
  • Phone: 303-716-8039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number0061848
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: