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General NPI Number Information
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NPI Number | 1568706893
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Entity Type | Individual
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Provider Name | LORI LYNN JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 11/27/2012
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Last Update Date | 01/17/2013
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Provider Practice Location Address
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Address Line | 3986 N OCEANA DR
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City | HART
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State | MI
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Zip | 49420-8358
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Country | US
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Telephone | 231-873-2193
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Fax | 231-873-4248
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Provider Business Mailing Address
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Address Line | 3986 N OCEANA DR
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City | HART
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State | MI
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Zip | 49420-8358
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Country | US
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Telephone | 231-873-2193
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Fax | 231-873-4248
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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 | 4704269946
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 4704269946
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License Number State | MI
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