Healthcare Provider Details

I. General information

NPI: 1396842100
Provider Name (Legal Business Name): PATRICIA J. JOHNSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W HIGHWAY 370
GRETNA NE
68028-4522
US

IV. Provider business mailing address

102 W HIGHWAY 370 P.O. BOX 527
GRETNA NE
68028-4522
US

V. Phone/Fax

Practice location:
  • Phone: 402-332-4559
  • Fax: 402-332-4598
Mailing address:
  • Phone: 402-332-4559
  • Fax: 402-332-4598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number110601
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: