1235534165 NPI number — ALEXANDRA LEIGH JOHNSON PA

Table of content: ALEXANDRA LEIGH JOHNSON PA (NPI 1235534165)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235534165 NPI number — ALEXANDRA LEIGH JOHNSON PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
ALEXANDRA
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOHLER
Provider Other First Name:
ALEXANDRA
Provider Other Middle Name:
LEIGH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235534165
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4545 R ST
Provider Second Line Business Mailing Address:
100
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68503-3799
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-465-4545
Provider Business Mailing Address Fax Number:
402-465-3621

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4545 R ST
Provider Second Line Business Practice Location Address:
100
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68503-3799
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-465-4545
Provider Business Practice Location Address Fax Number:
402-465-3621
Provider Enumeration Date:
11/04/2014

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: 363AM0700X , with the licence number:  1857 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1857 . This is a "LICENSE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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