Healthcare Provider Details

I. General information

NPI: 1356753131
Provider Name (Legal Business Name): MEGAN JOHNSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2014
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 YALE BLVD SE
ALBUQUERQUE NM
87106-4217
US

IV. Provider business mailing address

6317 MESQUITE DR NW
ALBUQUERQUE NM
87120-2511
US

V. Phone/Fax

Practice location:
  • Phone: 505-994-7999
  • Fax:
Mailing address:
  • Phone: 505-331-9964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN-70381
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: