1144508466 NPI number — MRS. ANGEL MADOLID JOHNSON ANP-BC

Table of content: MRS. ANGEL MADOLID JOHNSON ANP-BC (NPI 1144508466)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144508466 NPI number — MRS. ANGEL MADOLID JOHNSON ANP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
ANGEL
Provider Middle Name:
MADOLID
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ANP-BC
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:
ANGEL
Provider Other Middle Name:
MADOLID
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ANP-BC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1144508466
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12361 W BOLA DR
Provider Second Line Business Mailing Address:
STE 109
Provider Business Mailing Address City Name:
SURPRISE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85378-9021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-227-1000
Provider Business Mailing Address Fax Number:
623-227-2000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17218 N 72ND DR
Provider Second Line Business Practice Location Address:
SUITE #100
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85308-8580
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-334-8670
Provider Business Practice Location Address Fax Number:
623-334-8675
Provider Enumeration Date:
08/03/2011

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: 363LA2200X , with the licence number:  AP4112 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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