Healthcare Provider Details

I. General information

NPI: 1851385041
Provider Name (Legal Business Name): VIRGINIA P JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W 22ND ST
SIOUX FALLS SD
57105-1501
US

IV. Provider business mailing address

1310 W 22ND ST
SIOUX FALLS SD
57105-1501
US

V. Phone/Fax

Practice location:
  • Phone: 605-782-2000
  • Fax: 605-782-2721
Mailing address:
  • Phone: 605-782-2000
  • Fax: 605-782-2721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number0879
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: