Healthcare Provider Details

I. General information

NPI: 1073698692
Provider Name (Legal Business Name): MARGARET E JOHNSON MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4727 ROSEBUD LN
NEWBURGH IN
47630-9367
US

IV. Provider business mailing address

4727 ROSEBUD LN
NEWBURGH IN
47630-9367
US

V. Phone/Fax

Practice location:
  • Phone: 812-429-0772
  • Fax: 812-389-0877
Mailing address:
  • Phone: 812-429-0772
  • Fax: 812-389-0877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71006624A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12788915-4405
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3008080
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number14882
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: