Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 111676 | NE |
NPI | 1003216888 |
---|---|
Provider Name | Emily Nicole Johnson |
First Address | Fremont, NE 68025-2384 |
Second Address | Fremont, NE 68025-2384 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2014 |
Last Update Date | 08/09/2014 |