1871821496 NPI number — ANNETTE ISOM JOHNSON CNM

Table of content: ANNETTE ISOM JOHNSON CNM (NPI 1871821496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871821496 NPI number — ANNETTE ISOM JOHNSON CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
ANNETTE
Provider Middle Name:
ISOM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON
Provider Other First Name:
ANNETTE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CNM
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1871821496
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 E 3000 S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEBER CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84032-3646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-657-0945
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 E 3000 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEBER CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84032-3646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-657-0945
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/19/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367A00000X , with the licence number:  263590-4402 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)