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General NPI Number Information
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NPI Number | 1245491125
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Entity Type | Individual
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Provider Name | BRIDGET ANNE JOHNSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/23/2008
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Last Update Date | 06/25/2020
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Provider Practice Location Address
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Address Line | 3875 GEIST RD SUITE E381
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City | FAIRBANKS
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State | AK
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Zip | 99709-3549
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Country | US
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Telephone | 907-458-6943
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Fax |
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Provider Business Mailing Address
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Address Line | 512 WINDSOR DR
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City | FAIRBANKS
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State | AK
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Zip | 99709-3439
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Country | US
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Telephone | 414-405-2957
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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