Basic Information
| Provider Information | |||||||||
| NPI: | 1831562834 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | DANA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4207 | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756064207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9033154125 | ||||||||
| FaxNumber: | 9033154130 | ||||||||
| Practice Location | |||||||||
| Address1: | 703 E MARSHALL AVE | ||||||||
| Address2: | SUITE 5007 | ||||||||
| City: | LONGVIEW | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756015500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9033154455 | ||||||||
| FaxNumber: | 9033152466 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2015 | ||||||||
| LastUpdateDate: | 01/20/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP130054 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.