MEDICARE: CALLIE M 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	363LA2200X	Adult Health Nurse Practitioner	284012	MA
2	363L00000X	Nurse Practitioner	C-APN.0000856-C-NP	CO

General Provider Information

NPI Number	:	1881927408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALLIE M JOHNSON NP

Provider Business Mailing Address
First Line	:	2240 BUCHTEL BLVD STE 104
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-3447
Country	:	US
Telephone Number	:	303-871-2205
Fax Number	:

Provider Business Practice Location Address
First Line	:	2240 BUCHTEL BLVD STE 104
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-3447
Country	:	US
Telephone Number	:	303-871-2205
Fax Number	:

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

Provider Enumeration Date	:	09/14/2009
Last Update Date	:	03/17/2018

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