Healthcare Provider Details

I. General information

NPI: 1295970291
Provider Name (Legal Business Name): ANGELA JOHNSEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2008
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 S 86TH ST STE 102
LINCOLN NE
68526-9253
US

IV. Provider business mailing address

4444 S 86TH ST STE 102
LINCOLN NE
68526-9253
US

V. Phone/Fax

Practice location:
  • Phone: 402-476-7557
  • Fax: 402-476-9912
Mailing address:
  • Phone: 402-476-7557
  • Fax: 402-476-9912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number110908
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: