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NPI Code Detail

MEDICARE: MS. AMANDA KRISTEN JOHNSON-WO PA

MEDICARE: MS. AMANDA KRISTEN JOHNSON-WO PA
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
1363A00000XPhysician Assistant5924AZ

General Provider Information

NPI Number : 1992100887
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AMANDA KRISTEN JOHNSON-WO PA
Provider Business Mailing Address
First Line : 903 N 2ND ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85004-1906
Country : US
Telephone Number : 602-416-7600
Fax Number :
Provider Business Practice Location Address
First Line : 903 N 2ND ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85004-1906
Country : US
Telephone Number : 602-416-7600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2014
Last Update Date : 12/10/2014

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