MEDICARE: MS. TRUDIE N JOHNSON NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	10956-33	WI
2	363L00000X	Nurse Practitioner	10956	WI

General Provider Information

NPI Number	:	1295999480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRUDIE N JOHNSON NP

Provider Business Mailing Address
First Line	:	8628 W GRANTOSA DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53225-4941
Country	:	US
Telephone Number	:	414-535-1605
Fax Number	:

Provider Business Practice Location Address
First Line	:	8628 W GRANTOSA DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53225-4941
Country	:	US
Telephone Number	:	414-535-1605
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2008
Last Update Date	:	04/07/2026

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