1093037228 NPI number — MRS. HEATHER RENEE JOHNSON RN, BSN

Table of content: MRS. HEATHER RENEE JOHNSON RN, BSN (NPI 1093037228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093037228 NPI number — MRS. HEATHER RENEE JOHNSON RN, BSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
HEATHER
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, BSN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PROCTOR
Provider Other First Name:
HEATHER
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093037228
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 E UNIVERSITY AVE
Provider Second Line Business Mailing Address:
3 WEST
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50316-2302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-263-5153
Provider Business Mailing Address Fax Number:
515-263-5158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 E UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
3 WEST
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50316-2302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-263-5153
Provider Business Practice Location Address Fax Number:
515-263-5158
Provider Enumeration Date:
02/15/2010

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: 163WG0000X , with the licence number:  114291 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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