1619998242 NPI number — AMY L JOHNSON MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619998242 NPI number — AMY L JOHNSON MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

JOHNSON

Provider First Name:

AMY

Provider Middle Name:

L

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1619998242

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/21/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

515 22ND AVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

MONROE

Provider Business Mailing Address State Name:

WI

Provider Business Mailing Address Postal Code:

53566-1569

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

608-324-2000

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

515 22ND AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

MONROE

Provider Business Practice Location Address State Name:

WI

Provider Business Practice Location Address Postal Code:

53566-1569

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

608-324-2000

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

07/21/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208000000X , with the licence number:  036-079834 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 208000000X , with the licence number: 26994 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1000257 . This is a "PHYSICIANS PLUS" identifier . This identifiers is of the category "OTHER".
• Identifier: L86567 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 90002361 . This is a "WEA INS" identifier . This identifiers is of the category "OTHER".
• Identifier: 390808509 . This is a "CT GENERAL" identifier . This identifiers is of the category "OTHER".
• Identifier: 10869 . This is a "DEAN HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 30661700 . This is a "HIRSP" identifier . This identifiers is of the category "OTHER".
• Identifier: 30661700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
• Identifier: 390808509 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 390808509 . This is a "WPS" identifier . This identifiers is of the category "OTHER".
• Identifier: 39080850914 . This is a "UNITY" identifier . This identifiers is of the category "OTHER".
• Identifier: 370004381 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
• Identifier: 39080850930 . This is a "UNITY" identifier . This identifiers is of the category "OTHER".
• Identifier: 39080850960 . This is a "UNITY" identifier . This identifiers is of the category "OTHER".