Healthcare Provider Details

I. General information

NPI: 1760287700
Provider Name (Legal Business Name): LAURIE RENEE PAUP JOHNSON RN, NHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2025
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 W 2ND STREET LL200
GRAND ISLAND NE
68803
US

IV. Provider business mailing address

1811 W 2ND ST STE LL200
GRAND ISLAND NE
68803-5420
US

V. Phone/Fax

Practice location:
  • Phone: 308-833-3981
  • Fax: 308-382-0589
Mailing address:
  • Phone: 308-833-3981
  • Fax: 308-382-0589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number43960
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number43960
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: