Healthcare Provider Details

I. General information

NPI: 1144405622
Provider Name (Legal Business Name): LAURA DARLENE JOHNSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 SANDIA LOOP
BERNALILLO NM
87004-7076
US

IV. Provider business mailing address

9551 PASEO DEL NORTE NE
ALBUQUERQUE NM
87122-2975
US

V. Phone/Fax

Practice location:
  • Phone: 505-771-5116
  • Fax: 505-771-5127
Mailing address:
  • Phone: 505-800-7050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-07103
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: