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General NPI Number Information
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NPI Number | 1285280404
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Entity Type | Individual
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Provider Name | DANA D JOHNSON NP
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Gender | Female
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Dates
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Enumeration Date | 08/13/2019
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Last Update Date | 08/31/2020
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Provider Practice Location Address
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Address Line | 1501 UNION AVE STE A&B
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City | MOBERLY
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State | MO
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Zip | 65270-9469
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Country | US
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Telephone | 660-263-9095
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Fax | 660-263-0054
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Provider Business Mailing Address
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Address Line | 1501 UNION AVE STE A&B
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City | MOBERLY
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State | MO
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Zip | 65270-9469
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Country | US
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Telephone | 660-263-9095
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2015000816
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License Number State | MO
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