Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 150624 | MT |
NPI | 1154951192 |
---|---|
Provider Name | Stacey Lynne Johnson |
First Address | Great Falls, MT 59401-2510 |
Second Address | Great Falls, MT 59401-2510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2020 |
Last Update Date | 17/01/2020 |