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General NPI Number Information
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NPI Number | 1063697902
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Entity Type | Individual
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Provider Name | FREIDA JOHNSON-ALLEN APRN
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Gender | Female
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Dates
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Enumeration Date | 01/09/2008
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Last Update Date | 01/09/2008
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Provider Practice Location Address
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Address Line | 4568 HIGHLAND DR SUITE 290
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City | SLC
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State | UT
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Zip | 84117-4263
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Country | US
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Telephone | 801-274-6127
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Fax | 801-274-6129
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Provider Business Mailing Address
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Address Line | 4568 S. HIGHLAND DR. SUITE 290
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City | SLC
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State | UT
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Zip | 84117
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Country | US
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Telephone | 801-274-6127
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Fax | 801-274-6129
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 213057-4405
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License Number State | UT
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