MEDICARE: EILEEN MARY 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	363LG0600X	Gerontology Nurse Practitioner	62306	CO
2	363LF0000X	Family Nurse Practitioner	APN.0003418-NP	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CO 305289	OTHER	CO	MEDICARE NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780741777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EILEEN MARY JOHNSON NP

Provider Business Mailing Address
First Line	:	3205 N ACADEMY BLVD
Second Line	:	SUITE 130
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-5101
Country	:	US
Telephone Number	:	719-632-5700
Fax Number	:	719-344-7837

Provider Business Practice Location Address
First Line	:	4863 N NEVADA AVE
Second Line	:	SECOND FLOOR
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3951
Country	:	US
Telephone Number	:	719-632-5700
Fax Number	:	719-260-1821

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

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	04/04/2017

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Directions to “ EILEEN MARY JOHNSON NP” Practice Location

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