| Doctor Name: | MS. GILDA AUDREY JOHNSON |
| NPI Number: | 1053446583 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CPNP |
| License Number: | SP001395D |
| Business Practice Address: | 1991 Sproul Rd Suite 300 Broomall, PA - 190083512 |
| Business Phone Number: | 6103251390 |
| Business Fax Number: | 6103251373 |
| Mailing Address: | 1991 Sproul Rd, Suite 300 BROOMALL |
| State: | PA |
| Postal Code: | 190083512 |
| Phone Number: | 6103251390 |
| Fax Number: | 6103251373 |
| NPI Enumeration Date: | 02/23/2007 |
| NPI Last Update Date: | 09/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | SP001395D |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |