Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 113003 | NE |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | G075234 | IA |
NPI | 1023555638 |
---|---|
Provider Name | Ms. Cynthia Jean Johnson |
First Address | Carroll, IA 51401-3038 |
Second Address | Sioux City, IA 51105-1436 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2017 |
Last Update Date | 14/06/2021 |