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General NPI Number Information
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NPI Number | 1720541220
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Entity Type | Individual
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Provider Name | MARY ANNA JOHNSON FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 04/11/2019
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Last Update Date | 02/24/2021
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Provider Practice Location Address
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Address Line | 207 E MURPHY ST
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City | WALLACE
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State | NC
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Zip | 28466-1946
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Country | US
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Telephone | 910-285-4100
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Fax | 910-285-4766
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Provider Business Mailing Address
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Address Line | POST OFFICE BOX 968
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City | WALLACE
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State | NC
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Zip | 28466
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Country | US
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Telephone | 910-285-4100
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Fax | 910-285-4766
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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 | 5011650
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License Number State | NC
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