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General NPI Number Information
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NPI Number | 1730202623
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Entity Type | Individual
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Provider Name | AMANDA MOORE JOHNSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/07/2007
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Last Update Date | 03/20/2018
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Provider Practice Location Address
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Address Line | 2710 HARNEY ST STE 100
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City | LARAMIE
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State | WY
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Zip | 82072-0001
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Country | US
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Telephone | 307-742-9116
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Fax |
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Provider Business Mailing Address
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Address Line | 2710 HARNEY ST STE 100
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City | LARAMIE
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State | WY
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Zip | 82072-0001
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Country | US
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Telephone | 307-771-2884
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 241086
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD28544
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License Number State | OR
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