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General NPI Number Information
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NPI Number | 1114396207
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Entity Type | Individual
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Provider Name | JULIE A JOHNSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 4055 CASCADE RD SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-2149
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Country | US
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Telephone | 616-252-4410
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Fax |
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Provider Business Mailing Address
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Address Line | 4055 CASCADE RD SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-2149
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Country | US
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Telephone | 616-252-4410
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | TC675
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601007514
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2307
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10002201A
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License Number State | IN
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