Doctor Name: | MANDI JO JOHNSON |
NPI Number: | 1184090920 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-BC |
License Number: | 75549 |
Business Practice Address: | 921 Mineral Rd Ste 101 Glenville, WV - 263511342 |
Business Phone Number: | 3044627322 |
Business Fax Number: | 3044624052 |
Mailing Address: | 921 Mineral Rd Ste 101, GLENVILLE |
State: | WV |
Postal Code: | 263511342 |
Phone Number: | 3044627322 |
Fax Number: | 3044624052 |
NPI Enumeration Date: | 08/17/2015 |
NPI Last Update Date: | 08/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 75549 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |