Healthcare Provider Details

I. General information

NPI: 1043139462
Provider Name (Legal Business Name): MRS. MICHELE LYNN JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 S 2ND ST
NORFOLK NE
68701-5906
US

IV. Provider business mailing address

312 S 8TH ST
NORFOLK NE
68701-5112
US

V. Phone/Fax

Practice location:
  • Phone: 402-371-4944
  • Fax:
Mailing address:
  • Phone: 402-371-4944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: