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NPI Code Detail

MEDICARE: MR. PHIL H JOHNSON NP

MEDICARE: MR. PHIL H 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
1363LP0200XPediatric Nurse Practitioner204952-4405UT

General Provider Information

NPI Number : 1437323516
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PHIL H JOHNSON NP
Provider Business Mailing Address
First Line : 4650 HARRISON BLVD
Second Line :
City : OGDEN
State : UT
Zip : 84403-4303
Country : US
Telephone Number : 801-475-3000
Fax Number : 801-475-3414
Provider Business Practice Location Address
First Line : 3485 W 5200 S
Second Line :
City : ROY
State : UT
Zip : 84067-9438
Country : US
Telephone Number : 801-475-3900
Fax Number : 801-475-3901
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2008
Last Update Date : 03/07/2013

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