Basic Information
| Provider Information | |||||||||
| NPI: | 1447752035 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAURA L. JOHNSON, N.P., P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1619 NW HAWTHORNE AVE STE 204 | ||||||||
| Address2: | |||||||||
| City: | GRANTS PASS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975266009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419168530 | ||||||||
| FaxNumber: | 5419168533 | ||||||||
| Practice Location | |||||||||
| Address1: | 1619 NW HAWTHORNE AVE STE 204 | ||||||||
| Address2: | |||||||||
| City: | GRANTS PASS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975266009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419168530 | ||||||||
| FaxNumber: | 5419168533 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2018 | ||||||||
| LastUpdateDate: | 02/28/2018 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 5418908826 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | NP-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 201050002NP | OR | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 500616623 | 05 | OR | MEDICAID |