Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 5007496 | NC |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 5007496 | NC |
NPI | 1013300383 |
---|---|
Provider Name | Mrs. Julie Randolph Johnson |
First Address | Chantilly, VA 20151-1647 |
Second Address | Burlington, NC 27217-3900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2015 |
Last Update Date | 24/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013300383 | (05) | NC |