Healthcare Provider Details

I. General information

NPI: 1154560621
Provider Name (Legal Business Name): SARAH REBECCA JOHNSON RN, AOCNP, MSN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH REBECCA WILSON RN, AOCNP, MSN, NP-C

II. Dates (important events)

Enumeration Date: 02/06/2009
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 W FRIENDLY AVE
GREENSBORO NC
27403-1109
US

IV. Provider business mailing address

PO BOX 75216
CHARLOTTE NC
28275-0216
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-1100
  • Fax:
Mailing address:
  • Phone: 336-277-8800
  • Fax: 336-277-8850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024181288
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5004304
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: