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General NPI Number Information
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NPI Number | 1366536948
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Entity Type | Individual
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Provider Name | JUDITH L. JOHNSON APRN, CNS
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Gender | Female
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 523 W FLOATING FEATHER DRIVE
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City | EAGLE
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State | ID
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Zip | 83616
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Country | US
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Telephone | 208-938-8588
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Fax |
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Provider Business Mailing Address
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Address Line | 523 W FLOATING FEATHER DRIVE
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City | EAGLE
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State | ID
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Zip | 83616
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Country | US
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Telephone | 208-938-8588
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CNS18A, N10622
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License Number State | ID
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