1659745263 NPI number — HEIDI JOHNSON NP

Table of content: HEIDI JOHNSON NP (NPI 1659745263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659745263 NPI number — HEIDI JOHNSON NP

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659745263
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43 WHITING HILL RD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREWER
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04412-1006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-973-7334
Provider Business Mailing Address Fax Number:
207-626-1029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03756-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-650-8630
Provider Business Practice Location Address Fax Number:
603-650-2240
Provider Enumeration Date:
11/19/2015

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:  086110-23 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LA2200X , with the licence number: CNP151174 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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