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General NPI Number Information
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NPI Number | 1386668572
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Entity Type | Individual
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Provider Name | LARA ELIZABETH JOHNSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 05/31/2012
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Provider Practice Location Address
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Address Line | 13203 LADYBANK LN
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City | HERNDON
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State | VA
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Zip | 20171-4031
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Country | US
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Telephone | 580-251-0082
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Fax |
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Provider Business Mailing Address
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Address Line | 13203 LADYBANK LN
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City | HERNDON
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State | VA
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Zip | 20171-4031
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Country | US
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Telephone | 580-251-0082
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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 | PA05335
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License Number State | TX
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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 | 667
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License Number State | AK
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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 | 110003747
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License Number State | VA
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