Healthcare Provider Details

I. General information

NPI: 1821549619
Provider Name (Legal Business Name): BRIANA DAWN JOHNSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4071 S 4000 W
WEST VALLEY CITY UT
84120-4143
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 801-265-0103
  • Fax:
Mailing address:
  • Phone: 702-954-7672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number6523
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: