Healthcare Provider Details

I. General information

NPI: 1902521297
Provider Name (Legal Business Name): SALOME E JOHNSON DNP, APRN-CNP, PNPAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10705 HILLCREST PLZ
LA VISTA NE
68128-6703
US

IV. Provider business mailing address

12210 S 111TH ST
PAPILLION NE
68046-5893
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-8300
  • Fax:
Mailing address:
  • Phone: 336-469-7976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number101250
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: