| Doctor Name: | NICOLE JOHNSON |
| NPI Number: | 1336484286 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 7518925-8900 |
| Business Practice Address: | 150 N Main St Suite #105 Heber City, UT - 840321669 |
| Business Phone Number: | 4356541377 |
| Business Fax Number: | |
| Mailing Address: | 150 N Main St, Suite #105 HEBER CITY |
| State: | UT |
| Postal Code: | 840321669 |
| Phone Number: | 4356541377 |
| Fax Number: | |
| NPI Enumeration Date: | 12/04/2012 |
| NPI Last Update Date: | 03/07/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 7518925-8900 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | UT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |