Doctor Name: | STACY LYNN JOHNSON |
NPI Number: | 1467894220 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | R34077 |
Business Practice Address: | 420 Cty Rd. 26 Beulah, ND - 58523 |
Business Phone Number: | 7018736788 |
Business Fax Number: | |
Mailing Address: | 204 Main St W, GOLDEN VALLEY |
State: | ND |
Postal Code: | 585417131 |
Phone Number: | 7018700693 |
Fax Number: | |
NPI Enumeration Date: | 07/22/2013 |
NPI Last Update Date: | 07/22/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R34077 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ND |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |