Healthcare Provider Details

I. General information

NPI: 1699496422
Provider Name (Legal Business Name): MARYJANE DOWD JOHNSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 N DUKE ST STE 604
DURHAM NC
27704-3048
US

IV. Provider business mailing address

222 S RIVERSIDE PLZ STE 2120
CHICAGO IL
60606-6101
US

V. Phone/Fax

Practice location:
  • Phone: 866-284-8788
  • Fax:
Mailing address:
  • Phone: 480-308-2167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number83410
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number231765
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5025564
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberC-APN.0004133-C-NP
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberC-APN.0004133-C-NP
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberC-APN.0004133-C-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: