1245538396 NPI number — SARAH WOOD JOHANSON MSN, ACNP-BC, RNFA

Table of content: SARAH WOOD JOHANSON MSN, ACNP-BC, RNFA (NPI 1245538396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245538396 NPI number — SARAH WOOD JOHANSON MSN, ACNP-BC, RNFA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHANSON
Provider First Name:
SARAH
Provider Middle Name:
WOOD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, ACNP-BC, RNFA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WOOD
Provider Other First Name:
SARAH
Provider Other Middle Name:
C
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:
1245538396
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 872042
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASILLA
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99687-2042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-745-9401
Provider Business Mailing Address Fax Number:
907-746-2655

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2490 S WOODWORTH LOOP
Provider Second Line Business Practice Location Address:
SUITE 450
Provider Business Practice Location Address City Name:
PALMER
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99645-7410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-745-9401
Provider Business Practice Location Address Fax Number:
907-746-2655
Provider Enumeration Date:
03/14/2011

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: 363LA2100X , with the licence number:  1457 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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