Basic Information
| Provider Information | |||||||||
| NPI: | 1134649486 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 38 OAK ST | ||||||||
| Address2: | |||||||||
| City: | LAKE GEORGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128456021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182321016 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3 IRONGATE CTR | ||||||||
| Address2: | |||||||||
| City: | GLENS FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128013471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187934409 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2017 | ||||||||
| LastUpdateDate: | 06/27/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 341849 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.