Healthcare Provider Details

I. General information

NPI: 1922642032
Provider Name (Legal Business Name): LANIE ROSE JOHNSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 12/20/2019
Certification Date: 12/20/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 E SPRUCE ST
GARDEN CITY KS
67846-5614
US

IV. Provider business mailing address

401 E SPRUCE ST
GARDEN CITY KS
67846-5679
US

V. Phone/Fax

Practice location:
  • Phone: 620-275-3705
  • Fax: 620-275-3074
Mailing address:
  • Phone: 620-272-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0083528
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number79158
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: