MEDICARE: LORI JOHNSON NP-C

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	363LF0000X	Family Nurse Practitioner	71006065A	IN

General Provider Information

NPI Number	:	1679939987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI JOHNSON NP-C

Provider Business Mailing Address
First Line	:	3540 PUMP RD STE 1188
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23233-1115
Country	:	US
Telephone Number	:	804-404-6270
Fax Number	:

Provider Business Practice Location Address
First Line	:	675 JUSTICE WAY
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203-1574
Country	:	US
Telephone Number	:	804-404-6270
Fax Number	:

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

Provider Enumeration Date	:	01/04/2016
Last Update Date	:	03/04/2024

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