MEDICARE: MRS. DONNA JOHNSON BSN,MS,CRNP

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	363LA2100X	Acute Care Nurse Practitioner	R082022	MD

General Provider Information

NPI Number	:	1730176520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DONNA JOHNSON BSN,MS,CRNP

Provider Business Mailing Address
First Line	:	26840 POINT LOOKOUT RD
Second Line	:
City	:	LEONARDTOWN
State	:	MD
Zip	:	20650-1409
Country	:	US
Telephone Number	:	301-475-8091
Fax Number	:	301-475-6712

Provider Business Practice Location Address
First Line	:	26840 POINT LOOKOUT RD
Second Line	:
City	:	LEONARDTOWN
State	:	MD
Zip	:	20650-1409
Country	:	US
Telephone Number	:	301-475-8091
Fax Number	:	301-475-6712

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

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	08/11/2015

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