Healthcare Provider Details

I. General information

NPI: 1538936745
Provider Name (Legal Business Name): MICHELLE NICOLE JOHNSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 W WASHINGTON PALMS WAY
WASHINGTON UT
84780-8362
US

IV. Provider business mailing address

390 W WASHINGTON PALMS WAY
WASHINGTON UT
84780-8362
US

V. Phone/Fax

Practice location:
  • Phone: 435-313-3910
  • Fax: 908-742-3934
Mailing address:
  • Phone: 435-313-3910
  • Fax: 908-742-3934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6483184-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: