Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | APN.0992611.NP | CO |
NPI | 1003116997 |
---|---|
Provider Name | Stacey M Johnson |
First Address | Aurora, CO 80045-2545 |
Second Address | Aurora, CO 80045-2545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2010 |
Last Update Date | 11/04/2018 |