Doctor Name: | ADA DIANN JOHNSON |
NPI Number: | 1437553252 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN-BC |
License Number: | 57970 |
Business Practice Address: | 102 North Broadway Carnegie, OK - 73015 |
Business Phone Number: | 5806541050 |
Business Fax Number: | |
Mailing Address: | 102 North Broadway, CARNEGIE |
State: | OK |
Postal Code: | 73015 |
Phone Number: | 5806541050 |
Fax Number: | |
NPI Enumeration Date: | 10/22/2014 |
NPI Last Update Date: | 10/22/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 57970 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |