Healthcare Provider Details

I. General information

NPI: 1881196319
Provider Name (Legal Business Name): ALLISON JO JOHNSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MAC LN
PIERRE SD
57501
US

IV. Provider business mailing address

100 MAC LN
PIERRE SD
57501-3391
US

V. Phone/Fax

Practice location:
  • Phone: 605-224-5901
  • Fax:
Mailing address:
  • Phone: 605-224-5901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP001345
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: